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At least 1,099 records · Page 61Linked to original sources
PubMed1990

Heat and moisture exchangers and the body temperature: a peroperative study.

The importance of conditioning the inhaled gas for maintaining the body temperature during artificial respiration was investigated. The mean body temperature (MBT) was deduced from readings from five measuring sites, four of which were situated at the skin and the fifth in the rectum. Temperature recordings were made every 15th min. Twenty patients were admitted to the study. In 10 patients a heat and moisture exchanger was used (the HME group), and the other 10 were ventilated without an HME (the control group). The patients were normoventilated, and a non-rebreathing system was used. All operations were made in the ENT-region of the body. Great care was taken to avoid variation of external factors that may affect the MBT. We found that the MBT decreased 0.2 degrees C/h less in the HME group than in the control group. If corrections were made for differences in amounts of fluids given and age factors, a difference in heat loss of 41.6 kJ/h between the two groups could be derived from this figure. This difference was statistically significant. Our finding correlated fairly well with a predicted reduction of heat loss of 26.0 kJ/h for the type of HME used. A certain margin of error seemed to be inevitable in measuring body temperatures, and the reason for this is discussed. Our results support the fact that the investigation is adequately designed, and that the heat conserved with an HME is rather low.

Anesthesiology↗
PubMed1990

The effects of drugs on Sephadex-induced eosinophilia and lung hyper-responsiveness in the rat.

1. Rats given an intravenous injection of Sephadex particles (0.5 mg of G200 in 1 ml of saline) on days 0, 2 and 5 had a blood eosinophilia which was maximal on day 7. 2. On day 7, broncho-alveolar lavage (BAL) fluids taken from the rats contained an increased number of eosinophils and fewer mononuclear cells but there was no change in the small number of neutrophils. In addition the rats were hyper-sensitive to the increase in resistance to artificial respiration produced by 5-hydroxytryptamine (5-HT), given intravenously, with a shift to the left of the log dose-response curve. Lung parenchymal strips, taken from the rats on days 6, 7 and 8, were hyper-reactive to 5-HT with an increase in slope of the log dose-response curve. 3. Compounds with a wide variety of activities were evaluated for their effects on the blood eosinophilia on day 7 when given before each injection of Sephadex. The eosinophilia was reduced by glucocorticosteroids, beta-adrenoceptor agonists, aminophylline, dapsone and phenidone. 4. Dexamethasone, isoprenaline, dapsone and phenidone at doses that reduced the blood eosinophilia also reduced the changes in number of leucocytes in the BAL fluids and the hyper-responsiveness to 5-HT in vivo and in vitro, except that the effects of dapsone on the hyper-sensitivity to 5-HT in vivo did not reach significance. Aminophylline was the least effective of the drugs at reducing the blood eosinophilia and its effects on the other changes did not reach significance. Sodium cromoglycate reduced the BAL eosinophilia but had no effect on the other changes produced by Sephadex. 5. The correlation coefficients between blood eosinophil numbers and reactivity to 5-HT in vitro and sensitivity in vivo were r = 0.76, (n = 88; P < 0.001) and r = 0.53, (n = 61; P < 0.001) respectively. 6. Doses of dexamethasone, isoprenaline, dapsone and phenidone that reduced the blood eosinophilia when given before each injection of Sephadex were inactive when given up to 8 h after the Sephadex. 7. These data show an association between blood eosinophilia and hyper-responsiveness of the lung. The blood eosinophilia in the rats was triggered within the first few hours of injecting the Sephadex and drugs have been identified which inhibit this trigger.

Animals↗
PubMed1988

Characteristics of ongoing and reflex discharge of single splenic and renal sympathetic postganglionic fibres in cats.

1. Electrical discharge of thirty-nine single splenic and renal postganglionic nerve fibres was recorded in artificially respired, chloralose-anaesthetized cats. 2. Ongoing discharge rates, averaged over 10 s periods, did not differ between renal and splenic fibres. All neurones of both groups had irregular discharge frequencies. 3. Half of the splenic population and all renal fibres had cardiac-related discharge patterns. Of those tested for respiratory-related firing, 30% of the splenic fibres and 69% of the renal fibres exhibited this pattern. 4. Firing of splenic fibres was less inhibited than that of renal fibres by stimulation of pressoreceptors with phenylephrine-induced increases in blood pressure. Firing of splenic fibres also was less excited than that of renal fibres by unloading pressoreceptors with depressor doses of sodium nitroprusside. 5. Chemical stimulation of splenic afferent nerves with bradykinin consistently elicited greater increases in splenic than renal nerve discharge by causing large increases in firing of all splenic fibres and smaller excitatory responses in 75% of the renal fibres. 6. Application of bradykinin to the intestinal serosa produced greater increases in renal than splenic nerve discharge by consistently causing increased firing of renal fibres and by causing excitation, inhibition, or no change in splenic fibre discharge. 7. Responses of splenic and renal fibres to stimulation of splenic and intestinal afferent nerves after spinal cord transection were similar to those responses elicited when the neuraxis was intact. 8. In conclusion, the differential reflex responses of splenic and renal neuronal populations can be due to the heterogeneity or to the intensity of responses within a neuronal population.

Action Potentials↗
PubMed1976

Carboxyhaemoglobin dissociation in the cadaver following attempted resuscitation.

A series of 300 cases of fatal carbon-monoxide poisoning showed wide variations in carboxyhaemoglobin saturation. Levels below 50% in 24 subjects under the age of 70 were probably falsely low following attempted resuscitation on the way to hospital. Artificial respiration, especially with oxygen-rich gas, causes dissociation of carboxyhaemoglobin in the lungs of the cadaver while movement of blood into and out of the lungs, with mixing, lowers the saturation levels in the neighbouring large veins. In four cases subclavian blood showed saturation levels much lower than blood from sites further from the lungs. Blood should be taken from the femoral vein to get true readings.

Adult↗
PubMed1985

Pulmonary changes in congenital heart disease with Down's syndrome: their significance as a cause of postoperative respiratory failure.

Biopsy or necropsy specimens of lung from 28 patients with congenital heart disease and Down's syndrome were studied to establish the cause of the postoperative respiratory failure often seen in such cases. Changes in lungs seen after operation included interstitial emphysema and overdistension of peripheral air spaces, associated with hypoplastic alveoli and deficient elastic fibres in the alveolar wall. In specimens taken before operation alveolar hypoplasia was common but interstitial emphysema or overdistension of lower airways was found only rarely. Findings suggest that alveolar hypoplasia is characteristic of Down's syndrome and that distension of peripheral air spaces or interstitial emphysema was due to artificial inflation of the lung during surgery. The severity of the lesions correlated significantly with the duration of artificial respiration and with the severity of the respiratory failure. Hypoplastic lung tissue in patients with Down's syndrome appears to be more susceptible to mechanical stress, and this is likely to be the cause of postoperative respiratory failure.

Child↗
PubMed1975

Therapeutic problems in laryngo-tracheal stenoses.

History revealed iatrogenic injury (tracheostomy, intubation, artificial respiration) to be the reason for tracheal stenosis in each of our 32 cases (18 female, 14 male). So far 23 cases have been treated successfully and they live without a cannula; seven are still under treatment, while two patients died (severe heart-attack, spontaneous pneumothorax) and one refused further treatment. We were relatively successful in six cases of sleeve resection. All other 26 cases were treated by creating a tracheal groove, in which tracheal mucosa and skin of the neck were joined and the caudal end mostly kept open by using a pedicle skin flap. Intrathoracic stenoses require a sternotomy. An additional thyroidectomy and lateral traction to the tracheal walls by using loops out of the sternomastoid muscle became necessary in many cases and we obligatorily used tamponades of plastic inlay bolts, the average time of treatment being 8 months.

Adolescent↗
PubMed1998

[Measuring breath alcohol concentration during artificial ventilation. Model studies of the effect of temperature and humidity on measurements by various sampling systems].

The present paper examined the question as to the extent to which the taking of gas samples for the purpose of measuring the breath alcohol concentration (BAC) in the expired air of patients on artificial respiration is influenced by temperature and humidity. For this purpose a lung model standardized at different alcohol concentrations was used, in which the temperature (T: 25, 30 and 35 degrees C) and the relative humidity (RH: 50, 75 and 95%) were varied.

Breath Tests↗
PubMedDate not supplied

Neostigmine in the treatment of snake accidents caused by Micrurus frontalis: report of two cases (1).

Antivenom in order to be effective in the treatment of coral snake accidents must be injected very soon after the bite owing to the rapid rate of absorption of the venom neurotoxins. As this is not always possible, other forms of treatment besides serotherapy must be employed to avoid asphyxia and death. Neostigmine and artificial respiration are used for this purpose. Neostigmine restores neuromuscular transmission if the venom-induced blockade results from a reversible interaction of its neurotoxins with the end-plate receptors. This is the mechanism of the neuromuscular blockade produced by the venom of M. frontalis snakes from centereastern and southern Brazil, and Argentine. Neostigmine is able, therefore, to antagonize the blockade, and has been shown to be very effective in the treatment of the experimental envenomation of dogs and monkeys. In the present communication, two cases of M. frontalis accidents treated with antivenom and neostigmine are reported. In both, neostigmine was successful in producing regression of the paralysis, confirming the effectiveness shown in the treatment of the poisoning induced in animals by M. frontalis venom.

Adult↗
PubMedDate not supplied

Respiratory failure and lethal hypotension due to blue-ringed octopus and tetrodotoxin envenomation observed and counteracted in animal models.

The effects of crude blue-ringed octopus venom gland extract and tetrodotoxin (TTX) on anaesthetised rats and rabbits were studied. Paralysis of the respiratory musculature causing anoxia and cyanosis was overcome with positive, artificial respiration. The second lethal mechanism of the toxins: rapid and severe hypotension, had to be counteracted peripherally, since neural transmission had been drastically reduced by the toxins. Noradrenaline, d-amphetamine, phenylephrine and methoxamine, agonists acting on vascular adrenergic a-receptors, were tested.

Animals↗
PubMed1975

[Development of treatment of severe thoracic injuries].

About 25 p. 100 of cases of closed trauma of the thorax may be classified as severe, for they rapidly endanger life. Their treatment has made considerable progress since the report of J. Dor and H. Le Brigand in 1960. However, when severe trauma is treated, the mortality has remained unchanged over the last ten years. The treatment of fractures of the sternum includes respiratory assistance and internal fixation of the fractured bones, these two methods together, when correctly applied, give good results. Endothoracic lesions are now better recognised. Hemothorax and pneumothorax are now treated by a well recognised method. Visceral lesions, such as bronchial rupture, or major vascular ruptures, e.g. aorta, and heart lesions may be diagnosed at an early stage and be operated on more often. On the other hand, it is now better recognised that diffuse pulmonary lesions, e.g. pulmonary contusions or "shock lung", which is usually treated by artificial respiration alone, still may have a poor prognosis in some cases. From this it results that many surgical teams have enlarged the indications for early thoracotomy in the same way as laparotomy is more often carried out in abdominal trauma. In fact, these indications require circumspection and thoracotomy should only be carried out in specialised thoracic surgery units. If this is not available, aspiration, drainage, tracheotomy, continuous extension, are still applicable, but it is also necessary for them to be carried out correctly; if not, failures and complications of these minor measures are frequent. The use of these methods has shown the existence of therapeutic failures, including major bilateral bony lesions, diffuse severe lung injuries with resistant anoxia, complex multiple injuries with thoracic involvement and, finally, combined thoracic and cranial lesions, the mortality of which is about 50 p. 100. These facts explain why treatment of severe thoracic trauma gives variable results. The mortality varies from 12 to 15 p. 100, in some series up to 50 or 60 p. 100 These discrepancies may be explained by different modes of recruitment of the services, some of which receive a large number of very severe cases of multiple injury with a high mortality. However, over the last 15 years, one may consider that the general prognosis of severe thoracic trauma has improved considerably.

Fracture Fixation, Internal↗
PubMed1975

Blunt thoracic trauma in multiple injury.

In a series of 102 patients with multiple injury including a blunt lesion of the chest treated in 1970 through 1973 the mortality rate could be reduced to 17 per cent. This compares favourably with a mortality of about 34 per cent in a similar group of patients treated in the same hospital during 1965 through 1969. The improvement is partly due to increasing experience of the surgical and anaesthesiological teams and especially to a better appreciation of the importance of ventilatory pulmonary insufficiency and acute respiratory distress syndrome which are frequent in these patients. Early respiratory assistance is indicated in all cases with an instability of the chest wall. The imminence of a respiratory distress syndrome may announce itself by the classical symptoms of an increased breathing rate with hypocarbia before hypoxia becomes manifest. In the majority of patients with a thoracic lesion however the syndrome starts with a combination of increasing dyspnoea and normo- or even hypercarbia. This should be recognized and promptly treated by artificial respiration before acidosis and hypoxia with cardiac arrest can occur.

Abdominal Injuries↗
PubMed2003

[Severe acute respiratory syndrome (SARS)].

On November 2002, 305 cases of atypical pneumonia appeared in southern China. In February 2003, cases were reported in Hong Kong and from there the disease spread to many other countries, mainly, China, Hong Kong, Singapore, Vietnam and Toronto in Canada. The syndrome was defined as Severe Acute Respiratory Syndrome SARS), and a person is suspected of having SARS if he/she became ill after November 1 2002, has a fever exceeding 38 degrees C, has symptoms of a respiratory disease and was in a risk area or in close contact with a SARS patient within ten days prior the appearance of symptoms. The World Health Organization has received reports of 4,836 cases, of which 293 persons have died. Most were family members or medical staff treating the patient, persons who came into close and prolonged contact with the patient. The estimated incubation period is two days to one week. Symptoms of the disease include fever, shortness of breath and cough. Ten percent of patients afflicted with SARS require artificial breathing. The mortality rate is 6-7%. A novel coronavirus is associated with this outbreak, and the evidence indicates that this virus has an etiologic role in SARS. Infection is transmitted from person to person through direct or close contact with airborne droplets or personal objects of an infected person. Patients must be isolated and treated by contact and airborne isolation. Treatment consists of support care and artificial respiration when required. The use of anti-viral medications has not yet proven effective.

Canada↗
PubMed2003

[Toward the settlement and development of home care].

Ever since Sendai Ohshin Clinic inaugurated the operations in 1996, the clinic has been involved in the home care of 850 people in total. At present, the clinic provides care to 200 people at their homes including 38 people with serious diseases under artificial respiration and 40 people with terminal cancer. 513 people who were under care by the clinic died at home, and it is now quite natural that people live at home to the last breath. I noticed various issued through the provision of home care in Sendai and want to present the desirable direction of medical care using a couple of key words.

Aged↗
PubMed1991

[Analgosedation of the ventilated intensive care patient].

Seven different schemes for analgesic anaesthesia were investigated for their clinical applicability, potential side effects, and impacts on circulation parameters of the systemic and pulmonary (peripheral) circulation as well as on the intracranial pressure. In all, so patients per group were treated. The results revealed different reactions of patients, such as a higher incidence of disturbances of the autonomic nervous system and excitation after medication withdrawal. Favourable effects not only on clinical reactions but also on circulation parameters were seen during fentanyl/midazolam or alfentanil/midazolam therapy. In several instances, a clear increase in the right atrial and the pulmonary arterial mean pressure as well as the intracranial pressure was observed during ketamine/flunitrazepam therapy. The combinations pethidine/promethazine or pethidine/flunitrazepam also showed clear side effects on the circulation and evoked an increase in the intracranial pressure. Fentanyl/midazolam or alfentanil/midazolam treatments were the most favourable combinations for most of the patients who were artificially respirated.

Adolescent↗
PubMed1991

[Empyema necessitatis--a differential diagnostic problem in ventilated patients in intensive care].

Development of an empyema necessitatis under mechanical artificial respiration with high peak pressures is described on the basis of a case report on a patient in whom the phenomenon was the sequel of pneumonia with abscess formation. Conventional x-ray diagnosis can merely yield pointers towards possible differential diagnoses, whereas CT supplies an unequivocal diagnosis. X-ray image and differential diagnosis are discussed.

Aged↗
PubMed1991

The design of a user interface for a ventilator-management advisor.

The lack of user acceptance for many medical decision-support systems should force medical software developers to rethink strategies for user interaction with decision-support programs. Participatory design is an emerging method for the development for computer applications that emphasizes user involvement in both the design and implementation phases. We have applied participatory design to the development of a user interface for VentPlan, an application that assists physicians in the management of artificial respiration of critically ill patients. In this paper, we present a case history of the participatory design process and describe the resulting interface for the VentPlan program. As a result of applying participatory design ideas, we gained insight as to how to implement VentPlan more effectively.

Critical Care↗