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At least 1,153 records · Page 64Linked to original sources
PubMed1997

[Postoperative and post-traumatic acute cholecystitis. Value of ultrasound diagnosis].

An often unrecognized but potentially fatal complication, mostly seen in posttraumatic patients under intensive care, is reactive acute cholecystitis. On account of the high specificity of ultrasound diagnosis in the biliary system we decided to examine the ultrasound criteria for early detection of posttraumatic cholecystitis. Ultrasound of the abdomen was performed prospectively, seven times on different days, in each of 40 artificially respirated patients under intensive care conditions over a period of 12 months. The results show that artificial respiration, parenteral feeding and previous trauma can lead to tardive (28/40) wall-thickening or to a three-layered wall of the gallbladder (9/40). In 22.5% of patients (9/40) we found the sonographic signs of acute cholecystitis. In correlation with the clinical signs, cholecystectomy was indicated in only two patients. The preoperative ultrasonographic findings and clinical signs of 23 patients with the diagnosis of acute reactive cholecystitis were analysed retrospectively. We found good correlation between sonographic and clinical signs of acute cholecystitis in 21 of these 23 patients. Our study shows that the morphological correlate of a thickened three-layered gallbladder wall can occur in the context of systemic alterations, even if there is no underlying cholecystitis. The diagnosis of acute reactive cholecystitis and the indication for cholecystectomy should be based on the synopsis of pathologic and clinical findings.

Acute Disease↗
PubMed1997

[CT quantification of pleuropulmonary lesions in severe thoracic trauma].

PURPOSE: Computed quantification of the extent of pleuropulmonary trauma by CT and comparison with conventional chest x-ray--Impact on therapy and correlation with mechanical ventilation support and clinical outcome. METHOD: In a prospective trial, 50 patients with clinically suspicious blunt chest trauma were evaluated using CT and conventional chest x-ray. The computed quantification of ventilated lung provided by CT volumetry was correlated with the consecutive artificial respiration parameters and the clinical outcome. RESULTS: We found a high correlation between CT volumetry and artificial ventilation concerning maximal pressures and inspiratory oxygen concentration (FiO2, Goris-Score) (r = 0.89, Pearson). The graduation of thoracic trauma correlated highly with the duration of mechanical ventilation (r = 0.98, Pearson). Especially with regard to atelectases and lung contusions CT is superior compared to conventional chest x-ray; only 32% and 43%, respectively, were identified by conventional chest x-ray. CONCLUSION: CT allows rapid classification and quantification of pulmonary lesions after thoracic trauma and provides higher sensitivity and reliability. Because of the great correlation with the extent of artificial respiration in respect of duration and pressure, prognosis of the individual patient, as well as a differential therapy, appear possible.

Adolescent↗
PubMed1992

Influence of alprostadil on pulmonary dysfunction after a cardiac operation.

To test the effects of alprostadil on pulmonary dysfunction after cardiac operations, we studied 24 male patients undergoing aortocoronary bypass. Twelve were given an intravenous infusion of alprostadil (synthetic prostaglandin E1), 20 ng.kg-1.min-1, in a double-blind manner during operation; the other 12 were controls. Duration of artificial respirator use and frequent blood gas analyses were used to assess postoperative pulmonary function. Use of the artificial respirator postoperatively was significantly lower in the prostaglandin group (mean time. 5.25 +/- 1.81 hours) compared with the controls (mean time, 8.34 +/- 4.35 hours) (p = 0.047). The proportion of patients with hypercapnia and with hypoxia determined every 4 hours for the first 24 hours after extubation was significantly lower in the prostaglandin group compared with the controls (p less than 0.0001). These results indicate that synthetic prostaglandin E1 may play a role in protecting lung tissue during extracorporeal circulation.

Adult↗
PubMed1979

[H.R.P.-J.M.V.-200. A device for the simple adoption of modern ventilation techniques with various, even old, mechanical ventilators (author's transl)].

A new constructed device (H.R.P.-I.M.V.-2000) is presented. New techniques of artificial respiration such as E.S.-I.M.V., I.D.V., I.P.P.B. + P.E.E.P. compl., C.P.A.P. ect. can now be used with different types of respirators (pressure-, pressure-flow- and volume-time cycled) even older models. No constructional modifications, are necessary. To perform these techniques manipulation of only two control elements are necessary. Additionally hand ventilation is possible without any further device by the use of the H.R.P.-Respiration-Sets. The significance of E.S.-I.M.V. compared with I.M.V. and I.D.V. has between demonstrated. E.S.-I.M.V. has proved very valuable, because a basic mandatory respiratory is combined with the possibility of a patient-triggered expiration phase. Therefore fighting against the respirator is avoided. In addition the I.M.V.-device is the universal adapter for a new developed respiratory system (H.R.P.-System 2000) for different types of respirators. These sets (including a heated humidifier) are available as disposables or reusables and guarantee optimum hygiene during artificial respiration.

Humans↗
PubMed1982

Protective action of diazepam and of sympathomimetic amines against amitryptyline-induced toxicity.

Factors that contribute to the lethality of amitriptyline overdosage were studied in cats. Amitriptyline (50 mg/kg) given i.p. to unanesthetized cats produced convulsions in all of the animals and death in five of six animals; pretreatment with diazepam (5 mg/kg) protected against the convulsions and death. Respiratory depression contributed to the mortality when amitriptyline was given i.v. in cats anesthetized with pentobarbital as indicated by the finding that artificial respiration delayed the time of death induced by a continuous i.v. infusion of the drug. The i.v. infusion of amitriptyline in pentobarbitalized cats under artificial respiration produced death due to cardiovascular collapse. The latter was characterized by hypotension, bradycardia, depression of myocardial contractile force, atrioventricular block, intraventricular conduction delay and cardiac arrhythmias. These effects appear to be due to a direct membrane (quindine-like) cardiotoxic action of amitriptyline. Dopamine and dobutamine were effective in protecting the animals against the acute cardiovascular collapse induced by amitriptyline. The protection was associated with a diminution of the hypotension, the negative inotropic and chronotropic actions and the incidence of atrioventricular block produced by the tricyclic antidepressant drug. The results suggest that the positive chronotropic, inotropic and dromotropic actions of the amines may all be contributory factors in their protection action. Isoproterenol and norepinephrine were less effective than the other two amines.

Amitriptyline↗
PubMed1980

[Cardiovascular adaptation of the newborn to stress situations: effects of hypoxia on newborn and 14-day-old piglets (author's transl)].

-Newborn and 14-day-old piglets (in a developmental stage equivalent to that of a 3-month-old infant) compensate sustained hypoxemia by increasing cardiac performance. -This compensation can be maintained for only roughly 30 min. -Newborn piglets free from hypoxemia are able to tolerate the stress of anesthesia, artificial respiration, and operation significantly longer than those with additional hypoxemia. -14 day-old piglets without hypoxemia are not able to tolerate the stress of anesthesia, artificial respiration, and operation longer than those with additional hypoxemia. -The reactions of the cardiovascular system to anesthesia, artificial respiration, and operation in present or absent additional hypoxemia are qualitatively identical and are also identical in time in the newborn hypoxic, the 14-day-old hypoxic, and normoxic animals, whereas they appear significantly later in newborn control piglets.

Animals↗
PubMed1993

[Evaluation of a portable device for measuring maximal inspiratory pressure (Pimax)].

Pimax measurement is useful for quantifying the fatigue of the respiratory muscles (the "respiratory pump" of the mechanics of respiration), for controlling the therapeutic effect of artificial respiration performed at home, and assessment of the possibility of relieving a patient from artificial respiration. So far, such measurement had required complicated set-ups. A portable alternative is now available for Pimax measurement (MPM, distributed by Medanz, Starnberg, Germany). In a prospective study we compared the Pimax values measured via the mouth pressure measuring instrument under test, with the standard laboratory method. Statistical comparison of the measured data yielded a high degree of correlation (r = 0.97) with slight scatter of the individual data around the identity line. The portable instrument tested in this manner thus represents a mobile method yielding reliable Pimax values both on an inpatient and an outpatient basis.

Adult↗
PubMedDate not supplied

[A mathematical model of the biomechanics of respiration during artificial ventilation of the lungs].

The authors review a mathematic model of the respiratory biomechanics during artificial lung ventilation, presenting a subsystem of the mathematic model of respiration designed at the All-Union Research Surgery Center of the USSR AMS and used in the medical information diagnostic system elaborated for the Department of Resuscitation and Intensive Care, provide differential equations of the mathematic model, the results of the numerical solution of the model and an example of using the model for solving a private problem of selecting an adequate mode of artificial lung ventilation.

Biomechanical Phenomena↗
PubMed1989

[Surgical treatment of the unstable thorax in respiratory insufficiency].

Sixteen patients with traumatic flail chest underwent surgical stabilization using procedures introduced by Rehbein, Judet and Vecsei. Compared with sixteen patients treated by internal stabilization with intermittent positive pressure respiration, there are some advantages: time of artificial respiration is shortened, early mobilization is possible, nursing is easier, the costs are lower. The procedure is indicated in those patients, in whom long-term artificial respiration is not necessary for other reasons.

Flail Chest↗
PubMed1981

Procedures and modifications for reliable use of the unidirectional microflow respirator in the investigation of the carotid body of Gallus domesticus.

An artificial respirator was used to ensure successful and precise artificial respiration in short and long term experiments during radical exposure of the caudal cervical region and thoracic cavity to investigate cytological changes in the carotid body of mature chickens (Gallus domesticus). Modification of the respirator to stabilize gas flow, temperature and humidity consisted of replacing the ball check valve in the heating and humidifying cylinder with a fine regulating stopcock in the water outlet of the cylinder and inserting eight glass rods in a circle inside the cylinder. Accumulation of water condensate in the trachea and lungs during long term experiments was prevented by inserting a cotton filter moisture trap in the tracheal cannula.

Animals↗
PubMed1996

[Legal problems in management of home ventilation patients].

To prevent financial problems caused of homecare for patients with artificial respiration the prescription has to include the extent and the necessity of medical care which is much more than the care for the basic requirements. It has to be explained, that the lost of special homecare entails even intensive care in a hospital. Only in this way the health insurance has to pay for homecare of patients with artificial respiration without recourse to income and property.

Costs and Cost Analysis↗
PubMed1984

Selective cardiorespiratory effects mediated by mu opioid receptors in the nucleus ambiguus.

The respiratory and cardiovascular effects of the highly selective mu opioid agonist, D-Ala2, MePhe4, Gly- ol5 enkephalin ( DAGO ) and the relatively selective delta agonist, D-Leu5 enkephalin (DADL) were compared following injection (0.1 microliter) into the nucleus ambiguus (NA) of spontaneously-breathing and artificially-respired, pentobarbital-anesthetized rats. In non-ventilated animals, the opioids elicited dose-related (3 X 10(-11) -3 X 10(-9) M), naloxone-reversible depression of respiratory rate (RR) without altering the tidal volume. Mean arterial pressure (MAP) was unchanged at small doses and decreased at the largest dose; heart rate (HR) was unchanged. In artificially-respired animals, both peptides elicited dose-related, naloxone-reversible increases in mean arterial pressure and heart rate; DAGO was significantly more potent than DADL (P less than 0.01). Given the relative potency and selectivity of the opioids tested, these findings are consistent with the conclusion that mu receptors may selectively mediate the respiratory and cardiovascular actions of opioids in an important brain stem cardiorespiratory center in the rat. Moreover, these data indicate the importance of respiratory effects on the cardiovascular activity of centrally administered opioids.

Animals↗
PubMed2001

Risk factors for the development of polyneuropathy and myopathy in critically ill patients.

BACKGROUND: Previously, mainly retrospective and a few important prospective studies postulated the role of sepsis or systemic inflammatory response syndrome (SIRS), multiple organ failure, and the use of medication as causative factors for the development of critical illness polyneuropathy and myopathy (CIPNM). This study aimed to identify the risk factors in the development of CIPNM. METHODS: Prospectively, we studied 98 patients who were on artificial respirators for the development of CIPNM. The Acute Physiology and Chronic Health Evaluation (APACHE) III score, presence of SIRS, and sepsis severity score at entry; the dosage of midazolam, vecuronium, and steroids at entry and day 7 of artificial respiration; and the use of aminoglycosides at entry were related with time to CIPNM or time of last follow-up. The Kaplan-Meier method and log-rank test were used. RESULTS: Thirty-two patients (33%) developed CIPNM. After multivariate analysis, it was found that the APACHE III score and the presence of SIRS were significantly related with risk for the development of CIPNM. No significant relation was found for the use of midazolam, vecuronium, or steroids. Based on a risk index from a Cox regression model with APACHE III score and presence of SIRS as outcomes, three groups could be constructed with low-, medium-, and high-risk patients for the development of CIPNM. CONCLUSIONS: The APACHE III score, a quantitative index of disease severity based on clinical and laboratory physiologic data, is a valuable predictor for the development of CIPNM in patients in the intensive care unit. Together with the presence of SIRS, it can be used to estimate the risk of developing CIPNM for patients on artificial respirators.

APACHE↗
PubMed1983

Interaction of spontaneous respiration with artificial ventilation in preterm babies.

During a four-month period, all babies who received mechanical ventilation in the Neonatal Intensive Care Unit were studied to determine the effects of artificial ventilation on spontaneous respiratory activity. The babies were either totally apneic or ventilator inflation stimulated one of four distinct spontaneous respiratory patterns: synchronous breathing, Hering-Breuer reflex, augmented inspiration, or active expiration against ventilator inflation. The particular interaction evoked was dependent on the frequency of ventilation and the clinical condition of the baby. Only one pattern, active expiration against ventilator inflation, was consistently recorded before the development of pneumothorax. Preliminary evidence indicates that immediate paralysis of the baby as soon as that pattern is demonstrated may prevent the occurrence of pneumothoraces.

Blood Gas Analysis↗
PubMed1995

Pharmacist participation in cardiopulmonary resuscitation.

Pharmacist participation in cardiopulmonary resuscitation (CPR), including the basic life support (BLS) activities of artificial respiration and chest compressions, was studied. A questionnaire was mailed in September 1991 to the 197 graduates (1986-90) of a Michigan college of pharmacy requiring BLS training for graduation. Another questionnaire was mailed in April 1992 to the 181 pharmacy directors at all general acute-care hospitals in Michigan. The "graduate" survey covered practice setting, current status of BLS certification, use of BLS, and attitudes toward BLS training. The "director" survey covered the characteristics of the institution and its pharmacists, pharmacist involvement in CPR, and departmental BLS-training requirements. The response rates for the graduate and director surveys were 81% (160 questionnaires) and 76% (138), respectively. Only 66 (41%) of the graduates were currently certified in BLS, and only 77 (48%) had completed a BLS course since graduation. More than half (84, or 53%) indicated they had never been involved in any CPR activity. Activities most likely to be reported were drug preparation, dosage calculation, documentation, and drug information; very few pharmacists had given artificial respiration or chest compressions. Forty-six (33%) of the directors indicated that pharmacists routinely were members of the CPR team. Most (59%) of these 46 hospitals did not require BLS training for pharmacists. Hospital size significantly affected whether pharmacists were included on the CPR team. Hospitals with decentralized pharmacists were more likely than hospitals with centralized pharmacists to have pharmacist involvement on the CPR team. Both study groups expressed ambivalence about the value of BLS training for their current pharmacy practice situations.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗