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At least 829 records · Page 46Linked to original sources
PubMed1984

[Esophageal obturator tube, a new method for emergency artificial respiration].

Since several years, there are reports from the USA about the esophageal obturator airway, a simple device for emergency ventilatory support in the unconscious patient. The simplicity of its use is of advantage and may easily be achieved by paramedics too (blind insertion into the esophagus without the need of a laryngoscope). The occlusion of the esophagus prevents gastric inflation as well as regurgitation, emesis and aspiration. In our studies in anesthetized patients, the device proved to be effective. Still, preference should be given to endotracheal intubation whenever feasible. Several modifications of the EOA are discussed as well as possible complications.

Adolescent↗
PubMed1984

[Effect of metabolism-oriented substrate administration on energy and protein metabolism in polytraumatized artificial respiration patients].

An adequate "individually tailored" infusion and nutritional therapy is one of the essential prerequisites for an optimal healing process - especially in ventilated, polytraumatized patients with reduced compensatory capacities. There are nevertheless practically no publications dealing with the effect of substrate application adjusted to the measured metabolic rate on the energy and protein metabolism of the critically ill. In order to clarify this situation a prospective study was carried out on a group of 40 polytraumatized, ventilated patients, who were randomized into four groups, each receiving different infusion and nutritional regimen. The O2-consumption, energy expenditure, nitrogen balance and substrate concentrations in plasma and urine were determined, and the urea production rate and substrate turnover of all patients calculated. In the groups given nutritional support carbohydrate application adjusted to O2-consumption - lead to blood glucose concentrations which were persistently high. However, median values did not exceed 10 mmol/l and insulin application was never necessary. Energy expenditure - calculated from O2-consumption - averaged about 3000 kcal/day and was clearly below values previously reported in the literature for patients comparable to those studied in this investigation. There was no difference in energy expenditure between the patients treated with various infusion regimen. In none of the groups the median plasma urea concentration did exceed reference range. Despite an apparent improvement in nitrogen retention rate - through an increased amino-acid intake and a balanced energy input - an increased urea production rate resulted. When a balanced delivery of energy-yielding substrates is given, 2 g amino-acids/kg/day seems to be the upper limit of nitrogen support in the critically ill. 3-methylhistidine excretion in urine was parallel to urea production rate, indicating that the amino-acid sparing effect of carbohydrates is mainly derived from amino-acid conservation in muscle. These results seem to indicate that even in the early posttraumatic period a substrate application, adjusted to the measured turnover is possible without leading to a disturbance in homeostasis.

Adolescent↗
PubMed1984

[Brain function and artificial respiration].

Haemodynamic changes (cerebral perfusion pressure, cerebral blood flow) and variations of blood gases (especially paCO2) induced by mechanical ventilation, can influence cerebral function. The cerebral response to these changes is modified by the individual pathophysiology of the cranial contents. The cerebral mechanisms of adaptation allow a safe ventilation of a patient without cerebral disorders, provided ventilation is within normal clinical limits. In patients, however, whose mechanisms of adaption are impaired locally or globally, the pathophysiological situation may become grossly changed by variations in the ventilatory pattern. A therapeutical application of this interaction is controlled hyperventilation to lower intracranial pressure. On the other hand, changes in the ventilatory pattern (variation of PEEP-level, variation of minute volume, bronchial toilet) can impair cerebral function critically. As the individual reactions cannot be predicted in this group of patients, monitoring of haemodynamic parameters (MAP, CVP, CO), blood gases, intracranial pressure, and EEG is of utmost importance.

Acid-Base Equilibrium↗
PubMed1984

[Prevention of complications of the transnasal placement of artificial respiration tubes and catheters].

The anatomical variations of the nose and the nasopharynx concerning the possible complications in placement of transnasal tubes are discussed, such as problems with septal deviations, retropharyngeal or even intracranial aberration. In order to avoid complications attributable to these techniques the use of instruments designed for anterior rhinoscopy is recommended. No convenient and practicable instrument for routine use by an anaesthesiologist has been developed to date.

Humans↗
PubMed1983

Artificial respiration by phrenic nerve stimulation (diaphragm pacing) in patients with cervical cord and brain stem lesions.

In patients who are dependent upon respirators because of paralysis of respiratory muscles, pacemakers for electrical stimulation of the phrenic nerves, leading to contractions of the diaphragm, are available. We have implanted such diaphragm pacers in ten selected patients with partial or total respiratory insufficiency of central nervous origin. Preoperatively, transcutaneous phrenic nerve stimulation in the neck was undertaken with simultaneous fluoroscopy of the diaphragm and quantitative studies of ventilation and blood gases. Phrenic nerve stimulators were implanted bilaterally in eight and unilaterally in two patients. One patient died 3 weeks postoperatively from pneumonia, the remaining patients are entirely independent of respirator at a mean follow-up time of 20 months. Postoperative studies showed sufficient ventilation with diaphragm pacing in both sitting and recumbent body position. Their quality of life has improved. They still require permanent supervision and help with activities of daily life but all except one live in their homes. They can talk and some of them even attend school.

Adolescent↗
PubMed1984

[Artificial respiration of multi-injured patients with He-O2 and N2-O2 mixtures. II. Hemodynamics].

Multi-injured patients (n = 18) requiring ventilatory support were alternatively ventilated with either He-O2 or N2-O2 mixtures (FiO2 = 0.3). Haemodynamic effects in favour of He-O2 were especially seen in cardiac output in arising PEEP. It was the result of a reduced intrathoracic pressure when administering He-O2 mixtures for controlled respiration. These results must be seen in combination with the advantages of the ventilatory effects.

Helium↗