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Biomedical subjects

W Kachel

Publications and source records attributed to W Kachel.

35 records · Page 2Linked to original sources
PubMed1992

High frequency oscillatory ventilation and extracorporeal membrane oxygenation in severe persistent pulmonary hypertension of the newborn.

We report on 50 term and near-term neonates (birth weight greater than 1800 g, gestational age greater than 33 weeks) with severe persistent pulmonary hypertension of the newborn (PPHN), referred to us from January 1987 to July 1991 after failure of maximum conventional treatment. All infants had paO2 less than 45 mm Hg when ventilated with peak inspiratory pressure greater than 38 cm H2O and FiO2 = 1.0, hence meeting entry criteria for extracorporeal membrane oxygenation (ECMO). High frequency oscillatory ventilation (HFOV) was tried in all patients. If sufficient oxygenation could not be achieved (paO2 less than 40 mm Hg for at least 2 h), ECMO therapy was begun, which was the case in 25 children. Neonates responding to HFOV (n = 25) were of a slightly younger gestational age (37.0 weeks vs 38.8 weeks, P less than 0.05), had higher Apgar scores and were less hypoxaemic before HFOV (paO2 36.6 mm Hg vs 28.8 mm Hg, P less than 0.01); during HFOV there was a significant rise in paO2 (greater than 150 mm Hg; P less than 0.001) and a fall in pCO2 to 21.6 mm Hg (P less than 0.001). Due to air leaks, which was the main complication of HFOV (52%), ECMO therapy had to be begun in two additional infants after an initial positive effect. HFOV tended to be successful in cases of primary PPHN, meconium aspiration and sepsis, but not in infants with lung hypoplasia as a result of diaphragmatic hernia or other reasons. Success or failure of HFOV could not be reliably predicted by any parameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Gas Analysis↗
PubMed1992

Therapeutic use of surfactant in neonatal respiratory distress syndrome. Correlation between pulmonary X-ray changes and clinical data.

As part of a multicenter surfactant rescue study, the chest X-rays of 239 preterm and term infants were analyzed. To study the influence of surfactant administration on radiographic appearance, 130 patients with a clinical and radiological diagnosis of typical respiratory distress syndrome were selected, in whom adequate chest x-rays before and within 48 h after treatment were available. Median gestational age was 30 weeks (range 25-38 weeks), median birth weight was 1335 g (range 625-3450). The time of surfactant application ranged between 90 min and 24 h after birth (median 6 h). The most common finding after surfactant administration was uniform (n = 47) or disproportionate (n = 46) improvement of pulmonary aeration, which showed a significant correlation to posttreatment reduction of oxygen requirement (p less than 0.0001). Asymmetric clearance was more often localized on the right side and usually disappeared within two to five days. Only in 13 patients no change of ventilation was found. Development of interstitial emphysema (n = 24, including three patients with pneumothorax) after surfactant treatment was an unfavourable prognostic sign. 54% of these patients (13 of 24) died within the first month of life, compared to 8% (7 of 93) in the group of patients with initial improvement of ventilation.

Female↗
PubMed1992

[Fetal outcome of premature infants less than 1,500 g birth weight with special reference to surfactant requirements].

The objective of our study was to examine therapeutic success within a study group of 108 premature babies weighing less than 1500 g at birth. The foetal outcome was divided according to intrauterine betamethasone administration, method of birth and surfactant requirement. 59 of the babies did not require a surfactant factor, because within 12 hours it was possible, to reduce respiration to an O2 partial pressure of 20%. In 49 of the premature babies, this was not possible, and therefore, surfactant substitution was required, whereby this subject group was divided into surfactant responders and surfactant non-responders. In addition, we examined the influence of the method of birth on later survival and the occurrence of intraventricular haemorrhages in the children. A noticeably higher survival rate was determined in 81% of the children, born via Caesarean section, compared with 63% of premature babies, born via vaginal delivery. Likewise, detectable intraventricular haemorrhages (IVH) were significantly lower amongst premature babies delivered via Caesarean section (25%) than those delivered vaginally (37.5%). A considerable improvement in survival rates and a reduction in IVH was achieved by means of completed lung maturation with betamethasone (16 mg in 48 hours). 62% of premature infants with completed prepartal lung maturity did not require the administration of a surfactant due to the favourable respiratory situation. However, for those cases, where it was no longer possible to conduct lung maturation, only 46% did not require surfactant substitution. Therefore, it would appear advisable, to delay the delivery of premature babies weighing less than 1500 g in order to carry out lung maturity treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1992

Reconstruction of the arteria carotis communis in newborn following extracorporeal membrane oxygenation (ECMO).

With the help of ECMO it is possible to save the lives of newborn infants suffering from severe respiratory distress syndrome not responding to conservative treatment. Using Bartlett's classic venous-arterial perfusion technique in ECMO the right arteria carotis communis had to be sacrificed. Thus, despite the life-saving character of this new method, the ligation of the carotid with all its possible complications had often been a major argument against using this therapy. We are now therefore trying to reconstruct the arteria carotis after decannulating the vessel after extracorporeal membrane oxygenation. In our 8 cases so far, post-op examinations showed no obstruction of blood flow in the vessel. No neurological deficiencies were recorded.

Anastomosis, Surgical↗
PubMed1992

Indication for using extracorporeal membrane oxygenation in congenital diaphragmatic hernias and pulmonary hypoplasia.

Despite the apparent surgical simplicity of the anatomic defect, congenital diaphragmatic hernia continues to be a critical problem in neonatal surgery, so that survival is still uncertain. Therefore, we must realize that the barriers to survival are pulmonary parenchymal and vascular hypoplasia as well as the complex syndrome of persisting fetal circulation. However, new treatment methods, such as extracorporeal membrane oxygenation (ECMO), although controversial, may improve survival. We believe that no infant should be excluded from diaphragmatic repair or consideration for ECMO-support before accurate predictive parameters have been developed that take both pulmonary hypoplasia and pulmonary hypertension into account. ECMO additionally enables us to postpone the operation until stabilization of the newborn (Late Operation Protocol). Apart from this, we can probably improve the long-term results after ECMO by reconstructing the common carotid artery.

Combined Modality Therapy↗
PubMed1987

[Clinical application of extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure].

ECMO is a therapeutic alternative for newborns with respiratory insufficiency unmanageable by artificial ventilation. A modified heart-lung machine well suited for long-term application is used both to support life and to take over organ function, allowing this organ to rest and to recover. The ECMO-technique as practised in our group is equivalent to the venous-arterial bypass initiated by the Bartlett-team. Venous blood is drained from the right atrium via the right internal jugular vein. After passage through a membrane oxygenator and a heat exchanger it is returned in an arterialized state to the ascending aorta via the right carotid artery. Cannulation is followed by systemic heparinization. With a roller pump extracorporeal circulation is installed for 3-6 days with flow-rates of 80-120 ml/kg/min. The operation is performed under local anesthesia in the neonatal intensive care unit. The typical course of ECMO is stabilization for the first 24-48 hours on high bypass flow rates keeping paO2 at 50-60 mmHg with minimal ventilator settings (Pmax 20 mmHg. FiO2 0.3-0.4). Bypass flow rates can be reduced for the next 24 h and the patient is taken off and decanulated while on similar ventilator settings. Because of systemic heparinization intracranial bleeding is the main complication for a newborn child on ECMO. The incidence is about 10%. Premature infants per se have a high risk of major intracranial bleeding without ECMO. Therefore contraindications are infants under 35-weeks gestation, and a hemorrhage diagnosed by ultrasound prior to ECMO. Prediction of mortality is estimated by the alveoloarterial oxygen gradient (D [Aa] O2).(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Hemorrhage↗
PubMed1987

[Extracorporeal membrane oxygenation (ECMO). A treatment alternative for newborn infants with severe respiratory disorder].

Extracorporeal Membrane Oxygenation (ECMO) is a promising alternative for newborns with critical respiratory disease, where conservative management is no longer sufficient. - Indications for ECMO include mainly the diagnoses Persisting Pulmonary Hypertension (PPHN), Meconium-Aspiration and Congenital Diaphragmatic Hernia. In patients with a mortality-prognosis of 80-100% ECMO will raise survival rates to about 80% with a good general developmental prognosis. Conditions, trainee programs, and experiences up to the first clinical application of ECMO are reported.

Diseases in Twins↗
PubMed1982

[Immunothrombocytopenia of the newborn caused by platelet-specific antibodies (anti-P1A1) (author's transl)].

For the first time in the German speaking area 8 cases of neonatal immunothrombocytopenia caused by platelet-specific P1A1 antibodies could be ascertained. The disease is caused by fetomaternal incompatibility against platelet antigens. All mothers were healthy. The children showed a postnatal tendency for petechial haemorrhages. Cerebral haemorrhages occurred in two cases. Optimal treatment consists of administration of P1A1-negative platelets (perhaps of the mother). Demonstration of platelet antibodies is possible nowadays by adequate serological methods.

Adult↗
PubMed1981

[Ultrasonics in the differential diagnosis of space-occupying lesions of the kidney in children].

During the last few years the coordination of ultrasound, radiology and urologic surgery led to the diagnosis and treatment of numerous diseases of the kidney. From 1976 till the beginning of 1979 we were able to diagnose 50 expanding retroperitoneal processes. These were hydronephroses, malignant tumors and enlargement of the kidney due to inflammatory affections ensuing nephrolithiasis as well as urosepsis and shock. The fact that sonography is a harmless, non invasive, simple and often repeatable examination is the most important advantage. Provided that ultrasound diagnosing is performed by an experienced person, there is a good correlation to the common x-ray methods and specially recommended for postoperative controls.

Child↗
PubMed1980

[Dopamine-induced secondary cardiomyopathy (author's transl)].

When myocardial fibre necrosis was produced experimentally in rats by high doses of dopamine, the main lesions were found in the left ventricular and septal myocardium. They could also be demonstrated in the left atrium. This report, which concerns clinical observations, is suggestive of a secondary cardiomyopathy in humans due to dopamine. The following pathogenetic mechanism is envisaged. The effects of dopamine are due to myocardial depletion of high energy phosphates following maximal stimulation and the increased, though inadequate adaptation of coronary resistance. The release of norepinephrine is also important. Aggravating factors may include the disturbed relationships of pulmonary ventilaltion to perfusion and the opening and dilatation of arterio-venous shunts in the lung, with subsequent hypoxaemia.

Animals↗
PubMed1980

[Cardiac parameters of the newborn after tocolysis (author's transl)].

Since 1971 premature labor has been treated with Fenoterol and Verapamil in the Department of Obstetrics and Gynecology of the University in Mannheim. In animal experiments as well as in the isolated fetal cardiac muscle elective myocardial necroses were observed following stimulation with beta-sympathomimetics. These lesions are prevented by additional application of Ca++-antagonists. Fenoterol and Verapamil are capable of passing through the placenta. To evaluate the question whether a possible cardiac lesion of the infant is caused by tocolysis, 31 newborns of mothers after tocolysis were compared to a group of 19 infants without tocolysis. At the first day of life as well as at the age of 2 and 4 weeks ECG was registered, and the serum electrolytes K+, Ca++ and Mg++ were determined. At day 1 and day 4 as well as during the 2nd and 5th week CK and CK-MB were measured, and during the 2nd week the size of heart was registered. We were unable to demonstrate pathological cardiac findings in newborns following tocolysis which were related to the preceding medication.

Calcium↗
PubMedDate not supplied

[Assessment and therapeutic possibilities in posthemorrhagic hydrocephalus of the newborn infant].

Internal hydrocephalus follows intraventricular hemorrhage in about 10%. Progression is directly related to the degree of hemorrhage. Several studies confirmed that cerebral damage may occur without an increase of intracranial pressure or head circumference. Assessment and therapeutic consequences depend entirely on sonographic and clinical criteria. In our series, 40 of 135 neonates with intraventricular hemorrhage developed internal hydrocephalus. Therapy was necessary in 35 children, 11 died. Serial lumbar punctures were the most frequent therapeutic approach in 70% of the children. 40% required a shunt, usually a ventriculo-peritoneal system. In this group the proportion of Grade III and IV hemorrhage was high. In 25% external drainage for one week was necessary. 10% were treated with acetazolamide and furosemide. By this therapy shunt placement could be avoided in 9 children (69.2%), in the group with Grade III hemorrhage. In addition it was possible to postpone shunting to the third month on the average. 25 children were followed-up. 40% were normal or had a mild developmental delay. 60% were seriously handicapped. Poor neurodevelopmental outcome was related directly to hemorrhage Grade III and IV, therefore to brain damage in the early phase. To prevent additional lesions it should be emphasized that in infantile hydrocephalus best long-term results have been obtained if the process was controlled early rather than later.

Brain Damage, Chronic↗
PubMedDate not supplied

[High frequency oscillatory ventilation of infants with severe respiratory disorders: possibilities, risks and limits].

By pediatricians the high frequency oscillatory ventilation (HFOV) is used almost only in the neonatal period. We report on the administration of HFOV in infants with pulmonary insufficiency after failure of conventional ventilatory support. 6 infants (aged 2-7 months, all former preterm babies) were referred to our hospital due to severe pneumonia after unsuccessful conservative management. Indications for HFOV were hypoxia (mean paO2 41.8 mm Hg with FiO2 = 0.95 and mean airway pressure = 16.6 cm H2O) and/or air leak syndrome. In all cases a sufficient oxygenation could be achieved by HFOV, followed then by stepwise reduction of FiO2 and MAP. The air leaks receded. After 12-178 h on HFOV a successful switchback to conventional ventilatory support (at FiO2 = 0.48 and MAP < 12 cm H2O) was possible, all infants were extubated 6-15 days later. Possible risks of HFOV are air leaks, a necrotizing tracheobronchitis and hemodynamic changes due to compression of the heart and great vessels. With the at the moment in Germany available oscillatory ventilators HFOV as a rescue therapy must be limited for infants with a body weight below 5-6 kg.

Female↗
PubMedDate not supplied

[Persistent pulmonary hypertension of the newborn infant (PPHN)].

Persistent pulmonary hypertension of newborn (PPHN) is due to a defect in the adaptation of pulmonary resistance. The primary form occurs idiopathically, with meconium aspiration syndrome and with hypoplasia of the lung and is characterised by excessive muscular hyperplasia of pulmonary arteries. Secondary PPHN following hypoxia, septicaemia and shock is due to pulmonary vasoconstriction whereby thromboxane, leukotrienes and prostaglandins play a decisive role. Diseases of the pulmonary parenchyma and congenital cardiac malformations have to be excluded. The increased pulmonary resistance can be demonstrated by two-dimensional cardiography. The therapy consists of hyperventilation and tolazoline, which can be complicated by severe side-effects. High frequency oscillation and jet-ventilation are employed experimentally, Extracorporeal Membranoxygenation is a promising new method.

Echocardiography↗
PubMedDate not supplied

[Quantitative prognosis of mortality in newborn infants treated with artificial respiration].

Among the 5 indexes to estimate the mortality rate of ventilated newborns the alveolar-arterial oxygen gradient was elaborated as the best statistical model. By means of the probit method a quantitative estimation regarding mortality prognosis became possible. We could demonstrate that already mean values of the first 6 hours are able to give a very precise prognosis of mortality. Among the variables considered, a reduction of gestational age demonstrated a significant influence on the mortality rate. In contrary diagnoses of respiratory problems showed no influence. An increase in D(Aa)O2 raised mortality rate significantly. Using the D(Aa)O2-model the individual mortality rate for any ventilated newborn within an interval of (0.1) can be given.

Birth Weight↗