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PubMed2002

[Assistance for improving QOL of patients using artificial respirator--a case of the very aged].

The recent reform of the health insurance/Long-term Care Insurance resulted in the introduction of healthcare technology to home and patients can use even an artificial respirator in home medical care. However, both patients and family members have significant mental/physical burden, and in many cases, it may often be impossible to provide care to improve ADL/QOL. This time, a very old patient aged 88, who underwent artificial respiratory management, HOT, tracheotomy, tubal feeding, balloon catheterization and decubitus treatment among other medical cares, was discharged from the hospital and QOL was successfully improved by the care of family members and other various services. The success was mostly attributed to the endeavors of caregivers. In this article, we review the visiting nursing and assess what cares contributed to the improvement of QOL and discuss future assistance.

Activities of Daily Living↗
PubMed1985

[Artificial respiration technics].

In general there are two distinguishable methods of artificial ventilation: assisted spontaneous ventilation and controlled ventilation. Spontaneous ventilation can be supported by CPAP or PEEP, in order to improve oxygenation, and by IMV to improve CO2 elimination. Furthermore, high frequency low pressure ventilation may be used versus low frequency high pressure ventilation. Conventional IPPV may be supported by continuous endexspiratory pressure. In special cases IRV may be applied. High frequency low pressure ventilation methods may be used intra- and postoperatively as well as post-traumatically.

Humans↗
PubMed1981

[Relation between artificial respiration and blood circulation in lung surgery].

The investigation of parameters of the artificial pulmonary ventilation and hemodynamics of the greater and lesser circulation circles during operation on the lungs has shown these parameters to be most greatly changed at the stages of separation of the pulmonary root and dissection of the vessels and bronchi. Changes in the ventilatory regimen were not followed by changes in the pulmonary hemodynamics and gas composition of the blood.

Blood Circulation↗
PubMedDate not supplied

[The respirator injector as a possible cause of complications in high frequency artificial respiration of the lungs].

Improper design of an injector can cause pulmonary overdistension, fall in venous return, alveolar hypoventilation, insufficient humidification of inhaled gas and oxygen toxicity syndrome during HFJV. Functional characteristics of widely used injectors were determined and their role in the development of serious complications of HFJV is discussed. Special attention is paid to the flow resistance of the injector, its inner volume, ejection ratio, and maximum inspiratory pressure generated by the injector. Practical steps to avoid these complications are recommended.

Equipment Design↗
PubMed1985

[Artificial respiration: yes or no? Ethical reflections on border-line questions in intensive care medicine].

Artificial ventilation is a symbol for intensive-care medicine. Within the framework of possibilities and limitations of intensive care, artificial ventilation is often discussed on a highly emotional plane. Three case reports serve to show that, to avoid inadequate treatment, it will be necessary to consider not only medical problems but also ethical, anthropological and psychological aspects when deciding about controlled respiration.

Aged↗
PubMed1992

[Optimal pulmonary ventilation determined by the relation between end-tidal CO2 and arterial blood pressure in artificially respirated cat].

End-tidal CO2 (ET-CO2) provides a continuous and sensitive monitoring of proper pulmonary ventilation in artificially ventilated animals during single unit recordings of the central nervous system. To determine a reliable standard of ET-CO2 in anesthetized and paralyzed animal, the relationship between ET-CO2 and arterial blood pressure (ABP) was observed in cat under different ventilation level. The results showed that ABP changed tremendously with variation in ventilation, but remained constant at a normal level as long as ET-CO2 was maintained within the range between 4.0-5.0%, i.e. optimally at 4.5 +/- 0.5%.

Animals↗
PubMed1987

[The effect of stress ulcer prevention on the incidence of pneumonia in artificial respiration].

The role of stress ulcer prophylaxis in increasing the risk of pneumonia in ventilator patients was analyzed prospectively in 142 artificially ventilated patients at a medical and surgical intensive care unit (104 males, 38 females, mean time of ventilation 7.9 days, mean age 46.5 years). The pH of gastric aspirate and bacterial counts in gastric fluid and tracheal secretions were investigated daily. Identical isolates from gastric aspirates and tracheal secretions were typed by agglutination, bacteriocin, or phage typing. An average of 2.1 bacterial species were isolated in 80.5% of all gastric aspirates. Bacterial counts increased with rising gastric aspirate pH, which was especially true for Gram-negative and less so for Gram-positive organisms; colony counts of Candida sp. decreased slightly. In 31.6% of patients identical bacterial species were first isolated from gastric aspirates and 1 to 2 days later from tracheal secretions. Of these microbes that were first isolated from gastric aspirate and later from tracheal secretions, 50.3% were Gram-negative, 37.5% Gram-positive, and only 4.2% Candida sp. One-half of all bacterial aspirations occurred between the 2nd and 7th day of ventilation; 80% occurred within 11 days of ventilation. Only 20% of all migrations of Gram-positive organisms from stomach to respiratory tract lead to pneumonia, as compared with 60% of Gram-negatives. At a gastric pH below 3.4 the incidence of ventilation pneumonia was 40.6%; above pH 5.0 the incidence was 69.2% (P less than or equal to 0.05). As pH increased, the organism causing pneumonia was significantly more often isolated first from the gastric aspirate and 1 to 2 days later from the tracheal secretion of the same patient.

Anesthesia↗
PubMed1989

[Effects of diverse regimes of artificial respiration on the course of experimental toxic pulmonary edema].

In acute experiments on cats with closed chest the author studied the influence of artificial ventilation of increased frequency or volume on the pulmonary edema degree, foam formation intensity, pulmonary gas exchange and the animals survival in experimental pulmonary edema caused by intravenous infusion of mixture fatty acids. It was shown, that artificial ventilation of increased frequencies or volumes in pulmonary edema reduces the increase of the pulmonary coefficient and edema liquid quantity at the beginning of edema and it does not become stronger in following stages. Artificial ventilation of increased regimes decreases the foam formation, increases survival of the animals, delays the arterial pressure decrease, improves the pulmonary gas exchange. Artificial ventilation of increased frequency is more effective then ventilation of increased volume decreases foam formation and improves gas exchange in the lungs.

Animals↗
PubMed1982

[Hemodynamic and respiratory effects of tramadol during nitrous oxide-oxygen-artificial respiration and in the postoperative period].

The haemodynamic effects of intravenous tramadol (two different doses: 0.75 mg/kg b.w. or 1.5 mg/kg b.w.) during artificial ventilation with oxygen and nitrous oxide were investigated in 20 female patients before the start of operation. Haemodynamic changes were characterized by a moderate increase in blood pressure concerning systemic as well as pulmonary circulation. These effects were due to a rise in peripheral and pulmonary vascular resistance. Application of tramadol immediately after the end of operation (n = 20:10 patients following neuroleptanalgesia and 10 patients after anesthesia with halothane) led to a slight antagonizable decrease in respiratory frequency and respiratory amplitude as well as increase in paCO2. While during conventional pain-therapy no haemodynamic and respiratory side-effects of tramadol could be demonstrated, the typical qualities of opiates (postoperative ventilatory embarrassment) and unspecific adrenergic effects have to be taken into account after use of high doses for anaesthetic purposes.

Anesthesia↗
PubMed1976

[Long-term artificial respiration in the treatment of neonatal tetanus (author's transl)].

A case of severe neonatal tetanus is reported which developed seven days after birth. The child was transferred to the intensive care unit where she was artificially ventilated for 25 days via a naso-tracheal catheter. The temperature and humidity of the inspired air were carefully controlled. Muscle relaxants and sedatives were given at 2-4 hours' interval.

Ampicillin↗
PubMed1993

[Indicators for an impending need of artificial respiration in patients with muscular dystrophy].

In 1990 we examined 25 patients with Duchenne Muscular Dystrophy (DMD) or Spinal Muscular Atrophy type II (SMA-II). The purpose was to elucidate their general physical capability and find indicators for future need of artificial ventilation. We used interviews and measurements. The interviews were based on classifications described as 1) EAMDA, 2) VIGNOS, 3) BROOKE for use with DMD patients. Our own classification (called EK) is described and used. Moreover, we measured five parameters for the mechanical lung function, the strength of eight great muscle groups, and anthropometrical data. In January 1992, between two and 18 months after our examination, seven of the patients (all DMD) required artificial ventilation. Among the patients who needed artificial ventilation, we found the DMDs to have the lowest physical capability, as measured by the interview (EK and EAMDA) and the smallest values for forced vital capacity (FVC) and peak expiratory flow rate (PEF). All 11 patients with SMA-II could administer their lives without ventilator. Comparing their values with the DMD group, we would expect that several would need artificial ventilation. The reason why the SMA-II patients can manage without artificial ventilation is not clarified. Combining our classification (EK) and the value for FVC, we can predict the need for artificial ventilation among the participating DMD patients.

Adolescent↗
PubMed1990

[Pulmonary circulation in experimental pulmonary edema during diverse artificial respiration regimes].

In acute experiments on cats with closed chest by ultrasonic method the authors studied the blood flow in low-lobar pulmonary artery and the vein, the blood pressure in pulmonary artery, lung vessels resistance in experimental pulmonary edema caused by intravenous infusion of mixture fatty acids at artificial ventilation of increased frequencies or volumes, at was shown, that artificial ventilation of increased frequencies in pulmonary edema reduces the pressure increase in pulmonary artery, lung vessels resistance and increases the blood flow in pulmonary artery and vein. Artificial ventilation of increased volumes produces more intense pressure increase in pulmonary artery and lung vessels resistance than in initial ventilation but the blood flow was slightly changed. The authors assume that artificial ventilation of increased frequencies or volumes in pulmonary edema due to pulmonary circulation change reduces the pulmonary edema intensity at the beginning.

Animals↗
PubMed1994

[Evaluating lung failure and the limits of artificial respiration].

The treatment and outcome of the respiratory failure decisively depend on its pathophysiological background. Besides simple blood gas analysis the investigation of the respiratory mechanics, interstitial lung water and the monitoring of the pulmonary pressure are necessary for an exact diagnosis. As a scoring method of lung failure the classification by Murray and Morell is most common. In addition to normal volume or pressure controlled artificial ventilation the treatment of lung failure sometimes requires new but accepted modes of ventilation as inversed ratio ventilation, permissive hypercapnea and high frequency ventilation. New methods as negative pressure ventilation, extracorporeal lung ventilation and liquid or partial liquid ventilation are not common yet and should be used only under special conditions. As a supplement of these modes of ventilation the application of prostacyclins, nitric oxide, surfactant and inhibitors of the arachidonic pathway is under clinical investigation. A limitation of the treatment of lung failure should be considered in irreversible multiple organ failure.

Critical Care↗
PubMed1983

[Prognosis in complications of acute myocardial infarction requiring artificial respiration].

From 1978 to 1981, 818 consecutive patients with acute myocardial infarction were admitted, 112 (13.7%) of whom required artificial ventilation because of complications. Their mean age (62) corresponded to the mean age of all acute myocardial infarction patients (63). 28 (25%) survived the hospitalization and were followed after discharge. 2 were lost to follow-up. After a mean follow-up period of 26 months, 8 patients had died and 18 were still alive, none of them free of symptoms. There was no difference of age, duration of respirator therapy and maximal creatine kinase activity between survivors (group A) and nonsurvivors (group B). In 50% of patients cardiac failure leading to endotracheal intubation was triggered or made worse by arrhythmias. The remaining 50% of patients showed pure pump failure. Again in these two subsets, cardiac failure was significantly less marked in group A than in group B according to the hemodynamic findings. In conclusion, inpatient mortality in patients with acute myocardial infarction requiring artificial ventilation was high (75%) and hemodynamic findings were significantly worse in those not surviving. Patients discharged from the hospital also had a reduced life expectancy (less than 50% after 3 years).

Arrhythmias, Cardiac↗
PubMed1986

[High frequency jet ventilation in patients with acute respiratory failure. A comparison with conventional artificial respiration].

The major advantage of High Frequency Jet Ventilation (HFJV) in the treatment of patients with ARDS was commonly seen in better oxygenation and lower airway pressures, compared to conventional ventilation. Furthermore, HFJV seemed to be successful even in those patients in whom conventional ventilation had failed. We compared HFJV (f = 100/min, inspiratory time 40% to 50%) to conventional ventilation (f = 10/min, PEEP 5 to 10 cm H2O). For mean airway pressure and FIO2 equal values were chosen in both ventilatory modes. With HFJV paO2 was significantly (P less than 0.01) lower (82.2 +/- 28.2 mmHg compared to 139.2 +/- 23.5 mmHg), intrapulmonary shunting higher (29.2 +/- 19.6% compared to 15.3 +/- 6.4%) than with CV. Ventilatory volume required for normocarbia under HFJV was 25.6 +/- 5.4 l/min approximately equal to 341 +/- 81.8 ml/kg B.W. Pulmonary artery pressure (PAP 25.0 +/- 5.0 mmHg compared to 19.9 +/- 4.7 mmHg), central venous pressure (10.5 +/- 4.2 mmHg compared to 8.8 +/- 3.0 mmHg), pulmonary capillary pressure (13.3 +/- 4.4 mmHg compared to 11.3 +/- 3.7 mmHg), pulmonary vascular resistance (131.4 +/- 55.0 dyn . s . cm-5 compared to 96.7 +/- 33.7 dyn . s . cm-5) and right cardiac work index (1.38 +/- 0.55 kg . m/m2 compared to 1.05 +/- 0.33 kg . m/m2) were significantly increased (P less than 0.01) under HFJV. The other haemodynamic variables showed no difference between the two ventilatory modes. HFJV was inferior to conventional artificial ventilation in all patients and caused severe hypoxia in several patients, leading to pulmonary vasoconstriction and increased work of the right heart.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗
PubMed1975

[The clinical significance of controlled artificial respiration in patients with acute myocardial infarct].

It is reported on the results of the treatment with artificial ventilation in 20 patients with complicated myocardial infarction. As indicating sign a decreased arterial PO2 (lower than 70 Torr at an respiration of 50% O2 in the respiration air) was considered. Further references to clinical indications were depression of the breathing centre, severe pulmonary oedema, shock and life-threatening therapy-resistent disturbances of the rhythm. The long-term successes of the treatment with controlled respiration showed a clear dependence on the severity of the cardiac lesion and the general condition of the patient. In 10 cases only a transient improvement could be achieved. Three patients survived.

Adult↗