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At least 613 records · Page 34Linked to original sources

[High frequency jet ventilation as a form of artificial respiration in thoracic and abdominal surgery. Clinical experiences].

A total of 66 patients undergoing thoracic and abdominal surgery were ventilated with high-frequency jet ventilation (HFJV), using frequencies of 100 cycles/min (n = 33), 150 cycles/min (n = 21), and 200 cycles/min (n = 12). Inspiratory time was 30% and FIO2 0.4 (abdominal) and 0.5 (thoracic) respectively. Normocarbia required minute-volumes of 215.0 +/- 47.4 ml/kg (100 cycles/min), 256.0 +/- 39.2 ml/kg (150 cycles/min), and 298.0 +/- 41.0 ml/kg (200 cycles/min) respectively. With HFJV paO2-values were significantly below those under conventional ventilation (118.5 mmHg versus 153.2 mmHg; 137.5 mmHg versus 165.5 mmHg; 136.4 mmHg versus 156.7 mmHg). Heart rate, arterial blood pressure, and central venous pressure showed no differences. With HFJV 8 patients revealed paO2-values below 80 mmHg, 3 patients had to be returned to conventional ventilation because of severe hypoxia. HFJV is considered of no advantage over conventional ventilation and may cause prodigious hypoxia in patients with pulmonary dysfunction. Therefore, HFJV cannot be recommended in thoracic and abdominal surgery.

Abdomen↗

[Treatment of bronchopulmonary infections in patients during artificial respiration with imipenem/cilastatin].

In an open prospective study the efficacy and tolerance of imipenem/cilastatin was investigated in 24 critically ill patients on mechanical ventilation with nosocomial respiratory tract infection. Nine patients had previously received antibiotic therapy which had failed. Imipenem was given in a dose of 1-3g/24 h over 5-37 (mean 11) days. Seven patients were additionally treated with aminoglycosides, one patient with erythromycin. Pseudomonas aeruginosa, Staphylococcus aureus, Hemophilus influenzae and Escherichia coli were the most frequently isolated pathogens from tracheobronchial secretions. 91% of the infections without and 77% with involvement of Pseudomonas aeruginosa were successfully treated. All of the gram-positive and 85% of the gram-negative pathogens (Pseudomonas not included) were eliminated in the course of therapy. By contrast, 64% of the isolates of Pseudomonas aeruginosa persisted; half of these became imipenem-resistant. Nine patients showed adverse reactions including one case of pseudomembranous colitis which were reversible. Imipenem/cilastatin proved highly effective and was relatively well tolerated; limitations in the efficacy were seen in cases of infection due to Pseudomonas aeruginosa.

Adolescent↗

[Effect of various types of artificial respiration on raised intracranial pressure, associated with acute alcoholic intoxication].

The effects of spontaneous respiration and mechanical ventilation on ICP were examined by investigating the interaction between elevated pressure and alcohol intoxication. 200 ml ethanol 48% were infused in 11 young pigs with elevated cerebral pressure during mechanical ventilation (Group 1), 7 young pigs with elevated intracranial pressure during spontaneous respiration (Group 2), and 4 young pigs without elevated intracranial pressure during spontaneous respiration (Group 3). While the behaviour of intracranial pressure during mechanical ventilation in the animals from Group 1 was inhomogeneous with a tendency to rise (29 mmHg to 34 mmHg), intracranial pressure (28 mmHg to 55 mmHg) increased dramatically in Group 2. This increase was associated with a sharp rise of paCO2 (37.6 mmHg to 73.3 mmHg) and a decline of paO2 (74 mmHg to 13 mmHg). None of the animals in Group 2 survived. paCO2 also rose in alcoholized animals without elevated ICP (Group 3) (41.9 mmHg to 63.9 mmHg); intracranial pressure, however, remained within the normal range. All animals in Group 3 survived. Our findings indicate that elevated intracranial pressure and alcohol intoxication have a cumulative or potentiating effect on depression of the respiratory centre. Respiratory depression can be prevented by mechanical ventilation and, therefore, a further rise of intracranial pressure can be generally avoided.

Alcoholic Intoxication↗

[Acid gastroesophageal reflux in the child with intubation, artificial respiration and continuous nutrition. Apropos of 28 cases].

Continuous monitoring of distal oesophageal pH and oesophagoscopy were performed in 28 children aged 15 days to 12 years (mean: 14 months) intubated and ventilated for bronchiolitis (7), pneumonia (8), epiglotitis (2), neurological distress (8), whooping cough (2) or recurrent apneic spells (1). Esophageal pH was studied 2-8 days (mean: 2 days) after intubation; its duration was 12-23 h 50 min (M: 22 h). An abnormal gastroesophageal reflux was presumed when the percent of total monitoring time during which the esophageal pH fell below 4.0 was above 5.2%. The esophagoscopy was carried out on the day following the pH monitoring. All children were in the supine position and fed a pH 7 diet infused continuously with a nasogastric tube; 15 children were under pancuronium. An abnormal gastroesophageal reflux was found in 4 children, associated with a benign esophagitis in 2. A benign esophagitis without gastroesophageal reflux was found in 3 cases. One child had a peptic ulcer of the bulb without gastroesophageal reflux nor oesophagitis. 21 children had no abnormality. Only one of the 15 children under pancuronium had an abnormal gastroesophageal reflux. We conclude that in intubated children fed continuously with a nasogastric tube, gastroesophageal reflux is unfrequent and, when present, appears to have little consequences.

Enteral Nutrition↗

[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↗

[Intraoperative monitoring in artificial respiration of premature and newborn infants. II. Monitoring of arterial oxygenation].

Monitoring of adequate arterial oxygenation serves to avoid periods of hypoxaemia and hyperoxaemia with potentially life threatening or organ-damaging sequelae. Basic clinical monitoring, i.e., inspection and auscultation, is mandatory. In all infants, paO2 may be continuously and indirectly monitored by measurement of transcutaneous pO2 (tcpO2). The use of pulse oximetry for non-invasive measurement of arterial oxygen saturation (SaO2) is still undergoing clinical testing. Invasive monitoring of gas exchange is essential in prolonged or intrathoracic interventions as well as in neonates with cardiopulmonary problems. paO2 can be estimated by capillary blood gas analysis; arterial blood gas analysis, however, is required for exact determination of paO2 and of the arterio-cutaneous pO2 gradient (atcDO2). Intraarterial fibre optic determination of oxygen saturation or determination of paO2 with an intraarterial Clark electrode does not appear to be well suited for intraoperative conditions.

Anesthesia, General↗