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At least 307 records · Page 17Linked to original sources
PubMed1977

[Multiple organic replacement in intensive care medicine seen from anaesthesiological view (author's transl)].

Additional effective methods have to be studied for in order to improve further the treatment of life threatening conditions which are accompanied by reversible breakdown of organic functions. The development and the recent state of different technical and biological replacement functions are presented and their advantages and disadvantages are described. Temporary multiple organic replacement (lung, kidney, liver) by way of peripheral vessels offers a therapeutic procedure capable of development. This procedure is based on the knowledge that in different endogenous and exogenous intoxications, and also after shock symptomatology generally, several vital functions are simultaneously disturbed or become acutely insufficient. This coincidental breakdown requires a simultaneous, effective, multilateral therapy. First partial successes by means of equipment for multiple organic replacement are critically analysed and conclusions for further improvement of its function are discussed.

Artificial Organs↗
PubMed1976

[The prognosis of the transitory disturbances of av-conduction following cardiac surgery (author's transl)].

Out of 2250 cases with open heart surgery 106 patients were examined because of disturbances of av-conduction in the Department for Cardiology of the Childrens Hospital of the University of Göttingen. 38, 7 percent of all av-conduction disturbances have persisted, whereas 61, 3 percent were reversible. Especially the ventricular septal defects, the tetralogy of Fallot and the endocardial cushion defects are discussed. These lesions are predisposed for postsurgical av-disturbances because they are near to the av-conduction tissue. In this paper it has been demonstrated that the av-conduction disturbances, which last for more than one week, have only a little chance to return to sinus rhythm. Those which endure more than four weeks, will persist. The longer the av-conduction disturbances are lasting, the less is the possibility for restitution of sinus rhythm.

Adolescent↗
PubMed1976

Platelets, foreign surfaces, and heparin.

These studies clearly indicate that heparin has 2 antagonistic effects in this platelet-foreign surface interaction; it acts directly on platelets to increase retention, while acting on the foreign surface to reduce platelet retention, perhaps by competing for cationic sites. This study also suggests that it is unlikely that heparin bonding confers reduced surface thrombogenicity by virtue of the ability to leach off that surface and that further studies in heparin bonding or other surface modification should consider the antiplatelet effect which can easily be studied in vitro.

Blood Platelets↗
PubMed1976

Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy.

We have used prolonged extracorporeal membrane oxygenation (ECMO) in the treatment of 13 moribund infants (including 9 neonates), with 4 survivors (3 neonates). Successfully treated cases include post-operative cardiac failure, infant respiratory distress syndrome, massive meconium aspiration, and persistent fetal circulation. All cases have been managed with veno-arterial bypass at flow rates of 80-100 cc/Kg/min. Carotid cannulation for arterial access and careful control of heparin anticoagulation based on whole blood activated clotting time are among the techniques which have contributed to this success. Progressive pulmonary or cardiac failure has been the major problem in older infants, intracranial bleeding is the major problem in neonates. Both of these problems could be minimized by instituting ECMO earlier in the clinical course, but this awaits development of reliable early predictors of mortality.

Blood Coagulation↗
PubMed1986

Effect of 24-hour preservation with oxygen free radical scavengers on isolated-perfused canine heart-lungs.

The effectiveness of 24-hour hypothermic machine perfusion with TP-V (a hyperosmolar colloid solution containing dextrose, sucrose and ATP-MgCl2) alone, or in combination with oxygen free radical scavengers, was evaluated in isolated-perfused canine heart-lungs. Heart-lungs were perfused at 4 degrees C in either TP-V (n = 6), TP-V/Allopurinol (500 mg/L) (n = 6), or TP-V/Allopurinol (500 mg/L) & Catalase (5000 U/L) (n = 5). Lung inflation was maintained with 100% nitrogen. Following preservation, the heart-lungs were perfused with an albumin-mannitol perfusate for 3 hours at 37 degrees C, for functional, hemodynamic, and laboratory determinations. Cold preservation with TP-V/Allopurinol, and TP-V/Allopurinol & Catalase resulted in physiologically normal LDH levels during the 3-hour normothermic isolated perfusion test period. Significantly lower enzyme activity for CPK was evident at 0 (p less than .005) and 3 hours (p less than .05) of perfusion, while no significant differences in lactate production were seen among the groups. In addition, pH, PCO2, PO2, and left ventricular, aortic, and coronary artery pressures all remained within normal physiologic range, with no significant differences seen among the three groups. 99m Technetium scans demonstrated adequate patency among the heart-lungs, with better flow seen in those perfused with TP-V/Allopurinol & Catalase. Histological specimens confirmed a decrease in myocardial and pulmonary damage when Allopurinol and/or Catalase was used. It appears that oxygen free radical scavengers provide some protection from canine heart-lungs which have been hypothermically preserved for 24 hours.

Allopurinol↗
PubMed1988

Oxygen uptake during weaning from mechanical ventilation.

Total body oxygen uptake (VO2) increases during the transition from machine-assisted ventilation to spontaneous breathing. Since the volume of oxygen consumed by the respiratory muscles must contribute to the increase in VO2 (delta VO2), we explored whether delta VO2 and/or measurements of respiratory power output (Wresp) provide clinically useful information in the evaluation of disease state and weaning decisions in patients with respiratory failure. We determined the metabolic, ventilatory, and hemodynamic responses of ten patients during weaning from controlled mechanical ventilation, and compared delta VO2 and Wresp of patients without overt heart-lung disease (group 1) to that of patients with significant cardiopulmonary dysfunction and ventilator-dependent respiratory failure (group 2). We reasoned that for delta VO2 to be clinically useful, individual values must either clearly differ between groups, must be higher in patients with heart-lung disease, and/or correlate with weaning outcome and independent measurements of respiratory work. The VO2 increased in nine of ten patients. The differences between the groups in the values of delta VO2 (27 ml/min and 49 ml/min) and respiratory power (9.38 J/min and 11.99 J/min) were not significant. delta VO2 and Wresp were not correlated (r = 0.2), and neither predicted weaning outcome. We conclude that the sensitivity and specificity of delta VO2 and Wresp appear insufficient for evaluation of disease state and weaning decisions in individual patients.

Aged↗
PubMed1991

[The concept of lung and heart-lung preservation within the scope of multiple organ procurement].

Preservation of the lung is still one of the most challenging problems, because due to limited procurement time not all organs available can be used. The most common procurement technique is flush perfusion of the pulmonary artery system. Alternative methods in clinical use are either the autologous working heart-lung preparation or donor core-cooling (DCC). The own concept presented here, modified to the special demands of multi-organ-procurement, combines DCC and interstitial equilibration adapted to intracellular ion concentration. DCC is induced by extracorporeal circulation (ECC) using a transportable heart lung machine including a highly effective cooling system: cooling circuit based on two parallel heat exchangers with ice-water cooling produced by a high-pressure overflow of a low-temperature ice block (-40 degrees C). While cooling by ECC stepwise hemodilution is achieved by priming volume and incorporation of the cardioplegic solution (Bretschneider-HTK). The aim of equilibration is to lower the extracellular levels of sodium and calcium, and to increase the level of potassium. Additionally, the buffer capacity of donor blood is increased by the incorporated histidine-buffer system (alpha-stat). To avoid donor organ edema the time of ECC should be as short as possible. Using our system donor organ temperatures below 10 degrees C are reached within less than 30 min. In addition to ECC, lung surface cooling is achieved by external overflow with cold arterial blood (internal mammary artery). Besides lung preservation the main advantage of this concept is the profound precooling of all visceral organs before their individual flush perfusion.

Animals↗