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  • 1
    Electronic Resource
    Electronic Resource
    Additive effect on gas exchange of inhaled nitric oxide and intravenous almitrine bismesylate in the adult respiratory distress syndrome (1994)
    Springer
    Intensive care medicine 20 (1994), S. 254-259 
    Details
    ISSN: 1432-1238
    Keywords: Inhaled nitric oxide ; Almitrine bismesylate ; Adult respiratory distress syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To assess the additive effect of inhaled nitric oxide (NO) and intravenous almitrine bismesylate (ALM) on gas exchange. Design Prospective self-controlled study. Setting 3 medico-surgical intensive care units. Patients 17 patients with severe hypoxemia (PaO2/FIO2 ratio: 88±30mmHg, venous admixture: 47±7%) and elevated mean pulmonary artery pressure (MPAP: 30±5mmHg) due to adult respiratory distress syndrome (ARDS). Interventions 5 conditions were studied: 1) baseline, 2) 5 to 10ppm of NO during 30min, 3) discontinuation of NO during 30min, 4) ALM infusion (0.5mg/kg) during 30min, 5) ALM infusion (0.5mg/kg) during 30min in combination with 5 to 10ppm of NO. Measurement and results The PaO2/FIO2 ratio rose from 88±30 to 98±37mmHg (NS) with NO alone, and from 92±25 to 130±56mmHg (p〈0.01) with NO+ALM (p〈0.05 vs NO alone). Seven patients were considered as “NO-responders” (rise in PaO2/FIO2 ratio of 10mmHg or more with NO); in this subgroup the PaO2/FIO2 ratio rose from 87±30 to 128±39mmHg (p〈0.05) with NO alone, and from 93±20 to 169±51mmHg (p〈0.01) with NO+ALM (p〈0.05 versus NO alone). MPAP decreased from 30±5 to 26±5mmHg (p〈0.01) with NO alone, increased slightly from 28±5 to 31±5mmHg (NS) with ALM alone and decreased to 27±5mmHg (p〈0.05) with NO+ALM. Conclusions NO+ALM had additive effects on gas exchange while decreasing MPAP in patients with ARDS. The effects of NO alone were small and non significant, except in a subgroup of 7 patients in whom the combination of both therapies had the more pronounced results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01708960
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  • 2
    Electronic Resource
    Electronic Resource
    Cardiac asthma presenting as status asthmaticus: Deleterious effect of epinephrine therapy (1990)
    Springer
    Intensive care medicine 16 (1990), S. 466-468 
    Details
    ISSN: 1432-1238
    Keywords: Cardiac asthma ; Status asthmaticus ; Adrenergic agents ; Left heart failure ; mechanical ventilation ; Enoximone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Epinephrine is a potent bronchodilator currently used to treat severe asthma, although there is no proven advantage of this drug over ß2 adrenergic agonists. By contrast, as demonstrated here, the use of such a potent vasoconstrictor can worsen hemodynamic status when left ventricular dysfunction is associated with asthma or is the cause for dyspnea. We describe the case of a 60-year-old man with an history of chronic asthmatic bronchitis admitted for status asthmaticus. Bronchodilator therapy, including high dosages of intravenous epinephrine, failed to improve the patient and he was intubated and mechanically ventilated. Several hours later, a right heart catheterization revealed severe unexpected left heart dysfunction with a capillary wedge pressure of 45 mmHg and a cardiac index of 1.7 l/min/m2. Epinephrine was gradually stopped which resulted in a decrease in mean arterial blood pressure and an improvement of hemodynamic status. He was dischanged on home mechanical ventilation. In this patient, ischemic left heart failure was revealed by a clinical picture mimicking status asthmaticus. Epinephrine, given as bronchodilator therapy on an empiric basis precipitated the patient into cardiogenic shock. Therefore this drug should not be recommended in face of the possibility of cardiac asthma or associated cardiac dysfunction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01711229
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  • 3
    Electronic Resource
    Electronic Resource
    Dependence of shunt on cardiac output in unilobar oleic acid edema (1993)
    Springer
    Intensive care medicine 19 (1993), S. 185-190 
    Details
    ISSN: 1432-1238
    Keywords: Edema ; Oleic acid ; Pig ; Ventilation ; Lung blood flow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective In acute respiratory failure, increased cardiac output ( $$\dot Q_t $$ ) increase; shunt ( $${{\dot Q_s } \mathord{\left/ {\vphantom {{\dot Q_s } {\dot Q_t }}} \right. \kern-\nulldelimiterspace} {\dot Q_t }}$$ ). We have tested if this is caused by: 1) a redistribution of blood flow towards edematous regions, or 2) a decrease of regional ventilation in the edematous region. Design Oleic acid edema was induced in the left lower lobe (LLL) of 11 pigs. $$\dot Q_t $$ was varied with bleeding and infusion of blood and dextran. Blood flow to the LLL was measured at low and high $$\dot Q_t $$ with electromagnetic low probes in 6 animals and with a gamma camera in 5. In the gamma camera pigs regional ventilation was also measured. Measurements and results $$\dot Q_t $$ was increased by 45% (electromagnetic flow probes) and 73% (gamma camera). $${{\dot Q_s } \mathord{\left/ {\vphantom {{\dot Q_s } {\dot Q_t }}} \right. \kern-\nulldelimiterspace} {\dot Q_t }}$$ increased from 24.9–31.3% (p〈0.05) and from 17.6–28.8% (p〈0.001) respectively. No change in fractional perfusion of LLL could be seen, neither with flow probes nor with gamma camera. A decrease in ventilation of LLL, 2.6%, was observed when Qt was increased (p〈0.05). Conclusion Theoretically a small decrease in ventilation can explain the increase in shunt, if regions with low ventilation/perfusion (VA/ $$\dot Q$$ ) ratio are transformed to shunt. This is, however, unlikely since earlier studies have shown that blood flow is distributed either to regions with normal VA/ $$\dot Q$$ ratio or to shunt regions. We conclude that the cardiac output dependent shunt is not caused by redistribution of blood flow between lobes or by decreased ventilation in the edematous region. We cannot exclude that blood flow is redistributed within the edematous lobe.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01694768
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  • 4
    Electronic Resource
    Electronic Resource
    Difficult weaning (1993)
    Springer
    Intensive care medicine 19 (1993), S. S69 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01708804
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Expert Panel: The use of the pulmonary artery catheter (1991)
    Springer
    Intensive care medicine 17 (1991), S. I 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01704735
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  • 6
    Electronic Resource
    Electronic Resource
    Reporting on Consensus Conference (1992)
    Springer
    Intensive care medicine 18 (1992), S. 135-136 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709234
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  • 7
    Electronic Resource
    Electronic Resource
    A knowledge-based system for assisted ventilation of patients in intensive care units (1992)
    Springer
    Journal of clinical monitoring and computing 9 (1992), S. 239-250 
    Details
    ISSN: 1573-2614
    Keywords: Assisted ventilation ; knowledge-based system ; medical decision-making ; process control ; real-time ; weaning from mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract The procedure for weaning a patient with respiratory insufficiency from mechanical ventilation may be complex and requires expertise obtained by long clinical practice. We designed a knowledge-based system for the management of patients receiving respiratory support and implemented a weaning procedure. The system is intended for patients whose spontaneous respiratory activity is assisted by a Hamilton Veolar ventilator delivering a positive pressure plateau during inspiration (Pressure Support Ventilation mode). Our closed-loop real-time system running on a Personal Computer continuously adapts the assistance provided by the ventilator to the patient's evolution, and indicates when the patient can be withdrawn from the ventilator. Three parameters are used to appreciate the ‘respiratory comfort’ of the patient: breathing frequency, which we consider the most informative index, tidal volume and end-tidal CO2 pressure. A preliminary study of 19 patients was performed to evaluate the ability of our system to adapt the assistance to the patient's needs, with the main objective of facilitating weaning by gradually lowering the level of assistance. In 10 of these patients, considered as good candidates for weaning on the strength of objective criteria, the system maintained the breathing pattern in a zone of comfort for 95% of the period of assisted ventilation and stated that they were ‘weanable’. This was consistent with the clinical evolution of all 10 patients. These results show that such a system can provide effective management for mechanically ventilated patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01133619
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