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PubMed2004

[Home care of an ALS patient using an artificial respirator].

Due to social changes, advancement of medical technology and introduction of home care insurance, it has become a reality that a patient using an artificial respirator could be treated at home. We report specific problems associated with an ALS patient using an artificial respirator through home care support. A 68-year-old male had a back problem in 2001 and developed a sudden difficulty in breathing. Since 2002, the patient was forced to use an artificial respirator, and without taking his informed consent, was treated at home. Primary caregivers are his wife and daughter. The specific problems we identified are (1) patient's caregivers were unnecessary confused due to a lack of coordination between visiting nurses from two hospitals in giving home care treatment direction, (2) the care giver's burden tends to increase as the duration of care is extended because the short-stay facility or transferring system for patient is not well equipped, (3) there is no particular place to ask for assistance in case of an emergency or an established communication method as the patient's disease status will progress. It appears that these identified problems cannot be resolved by one hospital. However, we believe that we have to establish a community-wide home care system as quickly as possible. Meanwhile, it is important to have a nationwide coordination involving government, corporations, and political institutions to make it to be a success.

Aged↗
PubMed1989

Prophylaxis of respiratory tract infection in patients on artificial respiration.

In a pilot study, a prophylactic regimen including ciprofloxacin and amphotericin B was applied in 102 consecutive patients on artificial respiration for greater than or equal to 5 days to prevent respiratory tract infection with aerobic Gram-negative bacilli. Ciprofloxacin was given twice a day, as 500 mg through a gastric tube or 200 mg intravenously, and both applications led to negative cultures for aerobic Gram-negative bacilli from faeces and throat, except for a few periods of carriage lasting only a few days. No patient acquired respiratory tract infection with one of the Enterobacteriaceae or Pseudomonadaceae after 4 days of artificial respiration. In contrast to other prophylactic regimens in intensive care patients, this regimen is relatively simple and effective. These preliminary data suggest that this regimen should be studied further with special emphasis on the induction of resistance in Intensive Care Units using prospective, double-blind study designs.

Amphotericin B↗
PubMed1976

[Artificial respiration for the postoperative care after major surgery (author's transl)].

An analysis was made of the postoperative course of 158 cases of major surgery performed during 1971-1973. The operations comprised thoraco-abdominal resection of the oesophageal and cardia, abdominal duodenopancreatectomy, partial gastrectomy and enterectomy and partial hepatectomy. 63 per cent of the patients were given artificial respiration either prophylactically immediately after the operation (47 per cent) or at a later stage (53 per cent) on account of respiratory complications (arterial hypoxia below 55 mm Hg pO2). Postoperative mortality for the group of patients who did not have artificial respiration was 46 per cent, as compared with 32 per cent for the artifically ventilated patients - a difference of 14 per cent. The causes for this discrepancy, and especially the role of non-respiratory complications are discussed and the indications for prophylactic postoperative artificial respiration are reviewed.

Cardia↗
PubMed1986

[Respiratory minute volumes following end expiratory CO2 values in artificial respiration in anesthesia].

During artificial ventilation of anaesthetised patients the respiratory minute volumes were estimated after end tidal CO2-values (eeCO2) and correlated to arterial blood gases. In men the mean respiratory minute volume of 130 ml/kg body weight (b.w.) was significantly above the 113 ml/kg b.w. of women. 9.7-year-old boys and 16-year-old men had higher minute volumes (178 ml/kg b.w. and 148 ml/kg b.w. respectively) in comparison to men of 23 years of age. In contrast, no significant difference was seen in the older age groups. Overweight men had a significant lower respiratory minute volume (114 ml/kg b.w.), as compared to normal body weight (128 ml/kg b.w.), but overweight women had no significantly different minute volumes compared to normal body weight. During the course of anaesthesia for vaginal hysterectomy the respiratory minute volume had to be reduced in the first and second hour as compared to controls before the start of operation, in order to avoid excessive hyperventilation. EeCO2-values of 3.8 to 4.2 per cent by volume stand for a very marked hyperventilation in the pulmonary healthy patient. The arterial alveolar difference of the CO2 pressure (aADCO2) was in the normal range between 1 and 5 mmHg. The end tidal CO2 estimation is a noninvasive and suitable method to exactly meet the ventilatory needs of the anaesthetised patient.

Adolescent↗
PubMed1998

[The effect of temperature and humidity on breath samples. Measurement of breath ethanol concentration in artificially respirated patients].

UNLABELLED: When looking for the possible cause of distortions in values measured for the determination of breath ethanol concentration (BEC) in artificially respirated patients, consideration must be given to the humidity and temperature of the gas examined. In the present study, the effects of humidified and warmed and of dry and cold air on the accuracy of a newly developed BEC measuring device, as compared to a reference model and to a conventional system, were examined in a lung model. METHODS: A temperature-regulated pediatric incubator was used containing a 10 I gas reservoir and a breath humidifier with temperature regulated water bath. This setup provided constant temperature and humidity in the gas examined during measurement period. In the 'expiration' the air was directed from the breath humidifier through a measuring unit via a 'mouthpiece' into the reference system (Alcotest 7110, Dräger Inc., Lübeck) and then out. The measuring unit consisted of sensors for the temperature and relative humidity, and of a connector for the three sample extraction systems (PES). PES I was the conventional system with a 100-cm gas-sample pipe (Alcomed 3010), PES II the newly developed system (AlcoMed 3011, both from Envitec, Wismar) with a 10-cm gas-sample pipe, and PES III with a 20-cm heated gas-sample pipe. During 'inspiration' 2 l of air was fed into the system to rinse the measuring unit and to fill the reservoir. 61 measurements were performed with dry and cold air, and 71 with humidified and warmed air, in the course of which the ethanol concentration was increased from 0 to 1.5/1000. Data were evaluated using regression analysis and the Bland & Altman method. RESULTS AND CONCLUSIONS: The constancy of the values set for temperature, relative humidity and absolute humidity in the lung model was given for all measurements. In the dry and cold air, the results from all three test systems coincided almost perfectly with the reference values. The measured BEC in the humidified and warmed air using sample-extraction systems II and III corresponded to a high degree with the reference, while in the case of PES I, only a moderate linear correlation was achieved. The temperature and humidity of the expired gas during artificial respiration influence the gas samples extracted for the purposes of BEC measurement. Newly developed sample-extraction systems II and III coincide with the reference system, even under respiration-simulated gas conditions.

Breath Tests↗
PubMed1983

[Observation of the radiologic course in long-term artificial respiration].

In a retrospective study, 108 patients were followed up who had to undergo artificial respiration treatment because of respiratory insufficiency. X-ray diagnosis showed a shock lung in all the patients. X-ray morphology correlates with the pathologicoanatomical substrate which develops progressively in phases. 24 patients (22%) could be saved, which is a remarkable success in view of the usually fatal prognosis. It was encouraging to find that follow-up examinations of the surviving patients did not reveal any detectable sequels of the "shock lung"; likewise, no unfavourable effects of the respiratory therapy were noticed.

Adult↗
PubMed1976

[Disinfection of the inspired and expired air during artificial respiration with humified gases].

The water in the nebulizer of respirators is a potential source of infection for patients receiving artificial respiration. Interposition of a special equipment that will produce ozone-free ultraviolet radiation will prevent infection of the patient by the inspired humidified air, even if the bacterial count in the nebulizer fluid is very high. Interposition of the same equipment on the expiratory side is also recommended to minimize the risk of infection of the environment by bacteria in the expired air.

Air Microbiology↗
PubMedDate not supplied

Comparative studies of artificial respiration sets for babies and infants.

In experiments on appropriately modified manikins the action and effectiveness of artificial respiration sets for infants Penlon (British production) and Ambu (Danish production) were compared. The tidal volume, pressure and characteristics of respiratory phases, rebreathing, oxygen concentration, safety systems and their effect on ventilation were assessed. It was found that better ventilation parameters for the needs of resuscitation of newborns and babies can be obtained using the Ambu set, particularly when compliance is lower and bronchial resistance is higher. The Ambu set is simple, easy and safe to use.

Humans↗
PubMed1986

[Use of the double-lumen tracheostomy tube (Tracheopart) in bronchial stump insufficiency in long-term artificial respiration. Case report].

In long-term artificial respiration an insufficiency of the bronchial stump after pneumectomy must be considered as a result of the positive pressure respiration. Respirator treatment can be continued by means of a twin-lumen tracheostomy tube, the bronchial fistula being relieved of the stress while offering it an opportunity to close spontaneously. Good experience collected with the practical use of this method points to its suitability in prophylaxis as well.

Adult↗
PubMed1978

[Problems in prolonged artificial respiration. A review].

For about twenty years, the method for prolonged artificial respiration was an imitation of spontaneous breathing pattern. New pathophysiological informations about acute respiratory failure showed that a technique which is widely different in frequency, cycle, and tidal volume is more suitable for the fast and safe restauration of spontaneous breathing. Especially the determination of pulmonary shunt flow (QS/Qt), and of the ratio of dead space to tidal volume (VD/VT) have completed our knowledge. In the management of patients with prolonged artificial ventilation, the calculation of shunt flow allows an evaluation of therapeutic procedures. This was the reason to present a nomogram, which simplifies the determination of pulmonary shunt and to discuss an easy, non-invasive method to at least estimate its amount.

Humans↗
PubMed2006

Edward Schafer (1850-1935) and artificial respiration.

In 1861 the Royal Medical and Chirurgical Society of London set up a series of committees to examine different methods of manual artificial respiration for use in apparent drowning. In 1903 Edward Schafer, then Professor of Physiology at Edinburgh and chairman of the fourth committee, described his own prone-pressure method which, on the basis of recorded respiratory minute-volumes, was superior to other methods and subsequently was employed worldwide for nearly 50 years.

Drowning↗
PubMed1995

Axial movements of rat mandibular incisors measured under artificial respiration with halothane anaesthesia.

The axial movements of rat incisors were recorded continuously for over 20 h. The rats were anaesthetized with halothane delivered by intratracheal intubation using an artificial respirator. A haemostatic clamp was used to immobilize the jaw and the displacement detector exhibited high resolution, good linearity and low drift. The previously impeded and unimpeded eruption rates (the average extrusive movements) were 406 and 548 microns/24 h, respectively. The previously unimpeded rate was lower than the normal unimpeded rates obtained by other investigators. It appears that the eruptive movement of the previously unimpeded incisor was inhibited by halothane anaesthesia. Circadian rhythm was not observed in the eruption rates of previously impeded or unimpeded incisors. Following the i.p. injection of a lethal dose of pentobarbital sodium, the incisors retracted. The average intrusive movement was significantly greater in the previously impeded group (29 microns) than in the previously unimpeded group (12 microns) at 30 min after the lethal injection. It is assumed that the elimination of the pushing force at death may cause the stretched periodontal fibres to recoil, thereby pulling the tooth in an intrusive direction. It is also likely that the mechanical strength of the ligament is reduced in the previously unimpeded group by repeated shortening of the incisors; therefore the force needed to retract previously unimpeded incisors may be less than that needed to retract previously impeded incisors.

Animals↗
PubMed1981

Experimental studies on the effect of artificial respiration after lightning accidents.

Many suggestions have been made regarding protective methods against lightning, without any quantitative tests of safety. As a fundamental study on lightning protection, the lethal threshold energy for the artificial lightning impulse was investigated, using 14 rabbits. The voltage and current impulse had a 1 microsecond wave front and 40 microsecond wave tail. The imposed energy was measured by simultaneous photographic recording of both voltage and current waves on separate oscilloscopes. The impulse voltage was applied to head, neck, upper chest, and lower chest while the right hind limb was grounded. Artificial lightning current impulses were fed through the skin of the animals by making the surface flash over so that the surface flash was monitored carefully to delete the data of this case which gives an erroneous energy value from the statistical analysis. The lethal threshold energy was found to be 157.6 +/- 54.1 Joule (J), and the percentage of survival was 25% when 160 J impulse energy was given. Impulses of 160 J were then applied to the heads of 21 other rabbits maintained on an artificial respirator. Under these conditions the percentage of survival increased significantly to 47.6%.

Animals↗