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  • 1
    Electronic Resource
    Electronic Resource
    Effect of mucolytic and bronchodilator aerosol therapy on airway resistance in mechanically ventilated patients (1985)
    Springer
    Intensive care medicine 11 (1985), S. 316-318 
    Details
    ISSN: 1432-1238
    Keywords: Airway resistance ; Respiratory therapy ; Bronchodilator agents ; Mucolytic agents
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Nebulisation of a 10% solution of Mesna (Mistabron) in 10 postoperatively ventilated patients without preexisting pulmonary disease caused a significant increase in inspiratory resistance. This increase is effectively blocked by addition of a bronchodilator (i.e. Salbutamol) to the aerosol. No significant changes in airway resistance were observed in the 10 patients receiving salbutamol alone or isotonic saline. The expiratory resistance did not change suggesting that only the larger airways are involved in the constrictive effect of the drug. Although no patient showed clinical signs of bronchospasm, it is worth considering that even in patients without history of obstructive pulmonary disease nebulisation of Mesna should be performed in combination with a bronchodilator.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00273544
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Monitoring lung mechanics and airway pressures during differential lung ventilation (DLV) with emphasis on weaning from DLV (1989)
    Springer
    Intensive care medicine 15 (1989), S. 458-463 
    Details
    ISSN: 1432-1238
    Keywords: Monitoring ; Differential lung ventilation ; Compliance ; Airway resistance ; Pulmonary contusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Fifteen polytrauma patients with asymmetric pulmonary contusion were treated with differential lung ventilation (DLV) for a mean of 106 hours (range 24–298, median 83). The differential time constant (Tc), compliance (Ct), inspiratory and expiratory airway resistance (Rawinsp, Rawexp) and peak-airway pressure (Pawpeak) were monitored to evaluate the function of each lung. Values measured after starting DLV were compared to those obtained prior to stopping DLV in order to analyse whether these parameters had returned to symmetrical values when recommencement of conventional mechanical ventilation was considered on clinical parameters and also whether these could be useful criteria for weaning from DLV. The significant difference in Tc of the contused lung compared to the contralateral lung after starting DLV is mainly determined by altered Ct resulting from contusion. During DLV improvement of Ct resulted in identical Tc of both lungs prior to stopping DLV. Changes in the Rawinsp contributed little to changes in Tc. Identical Tc prior to stopping DLV coincided with identical Pawpeak on symmetrical ventilator settings. These data suggest that when less advanced monitoring equipment is available, the differential Pawpeak might be used as a measure of differential lung mechanics in asymmetrical pulmonary contusion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00255602
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Reflection of differential pulmonary perfusion in polytrauma patients on differential lung ventilation (DLV) (1989)
    Springer
    Intensive care medicine 15 (1989), S. 151-154 
    Details
    ISSN: 1432-1238
    Keywords: Monitoring ; Differential lung ventilation ; Differential pulmonary perfusion ; Lung contusion ; Polytrauma ; End-tidal CO2 ; Carbondioxide production
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Seventeen polytrauma patients with asymmetric pulmonary contusion were treated with differential lung ventilation (DLV). The ratios of differential values of end-tidal CO2 concentration (ETCO2) and CO2 excretion ml/min ( $$\dot VCO_2 $$ ) were compared as indirect parameters for differential pulmonary perfusion. Both CO2-derived methods indicated asymmetry after starting DLV suggesting asymmetric pulmonary perfusion as a consequence of contusion. Prior to stopping DLV a significant improvement in asymmetry was indicated by the differential ratios of ETCO2 and $$\dot VCO_2 $$ values. The ETCO2 ratio increased from 0.74±0.17 to 0.88±0.10, the $$\dot VCO_2 $$ ratio from 0.57±0.23 to 0.86±0.11. In two patients with very severe contusion who underwent bilobectomies a marked difference between the ratios of ETCO2 and $$\dot VCO_2 $$ was observed. It is concluded that differential measurement of CO2-derived variables may be useful in indicating differential perfusion in clinical practice on DLV. In very severe asymmetric contusion ETCO2 ratios may underestimate the differential perfusion ratio.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01058565
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Nosocomial gram-negative pneumonia in critically ill patients (1986)
    Springer
    Intensive care medicine 12 (1986), S. 419-423 
    Details
    ISSN: 1432-1238
    Keywords: Pneumonia ; Nosocomial ; Gram-negative ; Intensive care ; Artificial ventilation ; Infection prevention
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The efficacy of selective decontamination of the oral cavity and GI-tract in the treatment of established gram-negative pneumonia in critically ill patients was evaluated in a prospective open trial. 25 patients with pneumonia caused by Enterobacteriaceae or Pseudomonadaceae were studied. All patients were mechanically ventilated (range 2–60 days). Non-absorbable antibiotics (polymyxin E 100 mg, tobramycin 80 mg, amphotericin B 500 mg) were administered through the nasogastric tube four times a day. The oral cavity was decontaminated with an ointment containing 2% of the same antibiotics, applied to the buccal mucosa four times a day. For systemic therapy a combination of tobramycin (3–6 mg · kg-1) with either cefotaxim (50–100 mg · kg-1) or ceftazidime (100 mg · kg-1) was given both intravenously and by aerosol (50% IV dose/5 ml saline) four times a day. Eradication of pathogens from the respiratory tract was achieved in 24 patients within 9 days (median 5 days). The cure rate was 96%. Two patients had a relapse. Neither recolonization with resistant organisms nor supra-infections were found for the remaining period of mechanical ventilation (up to 60 days), also after systemic/aerosol therapy had been discontinued. Only 3 patients died (12%).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00254674
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Selective decontamination of the digestive tract improves survival in patients receiving differential lung ventilation (1988)
    Springer
    Intensive care medicine 15 (1988), S. 15-18 
    Details
    ISSN: 1432-1238
    Keywords: Differential lung ventilation ; Independent lung ventilation ; Infection prevention ; Selective decontamination ; Endobronchial intubation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a review of the literature on differential lung ventilation (DLV) the average mortality was found to be 47%. The major cause of death (66%) was infection. The effect of a novel infection prevention regimen on the colonisation and infection rate of the respiratory tract and on outcome was studied in polytrauma patients. Nineteen patients who presented with asymmetric pulmonary contusion were treated with DLV (103±72 h) and conventional mechanical ventilation (CMV) (16±10 days). They were treated with selective decontamination of the digestive tract with topical non-absorbable antibiotics in combination with systemic antibiotic prophylaxis starting immediately after admission. In one patient colonisation of the respiratory tract was found with Staphylococcus aureus. This disappeared after continued systemic antibiotic prophylaxis. Colonisation with hospital-acquired Gram-negative bacteria or yeasts was not observed. No patient developed pneumonia throughout the period on conventional mechanical ventilation or on DLV. One patient died from cerebral injury. It is concluded that prolonged endobronchial intubation for DLV can be used without increased risk for pneumonia with this antibiotic regimen and that the very low mortality in this study may be attributed to the prevention of infectious complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00255629
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  • 6
    Electronic Resource
    Electronic Resource
    Treatment of massive unilateral pulmonary embolism by differential lung ventilation (1987)
    Springer
    Intensive care medicine 13 (1987), S. 422-424 
    Details
    ISSN: 1432-1238
    Keywords: Pulmonary embolism ; Differential lung ventilation ; Monitoring ; Carbon dioxide production
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A patient with massive unilateral pulmonary embolism was treated with thrombolytic therapy and differential lung ventilation and selective PEEP. Differential lung ventilation affords besides therapy, selective monitoring of VCO2. Effects of thrombolytic therapy and SPEEP were evaluated by monitoring differential VCO2. Hypercapnia persisting in spite of conventional mechanical ventilation reducted remarkably after starting differential lung ventilation with selective PEEP on the noninjured lung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00257689
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    Paper (German National Licenses)
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  • 7
    Electronic Resource
    Electronic Resource
    Monitoring differential CO2 excretion during differential lung ventilation in asymmetric pulmonary contusion. Clinical implications (1988)
    Springer
    Intensive care medicine 14 (1988), S. 106-109 
    Details
    ISSN: 1432-1238
    Keywords: Differential lung ventilation ; Differential carbondioxide production ; Unilateral lung contusion ; Monitoring ; Polytrauma ; Differential pulmonary perfusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Eighteen severely injured polytrauma patients (ISS 38±18) with severe asymmetric pulmonary contusion were ventilated with differential lung ventilation (DLV) to improve oxygenation and/or to prevent further unnecessary barotrauma to the lesser involved lung. Differential VCO2 was studied as a parameter for indirect measurement of effective individual pulmonary perfusion. One hour after starting DLV, difference in differential VCO2 (delta VCO2) was 81±57ml/min. In 16 patients this had fallen significantly (p〈0.001) to 32±30ml/min, 1 h before DLV was discontinued. In 2 patients, VCO2 remained 〉 than 200ml/min, coinciding with clinical deterioration and increasing consolidation of the pulmonary contusion. Bilobectomies were performed in both patients. The excised lobes appeared to be destroyed as the result of laceration, bleeding and subsequent haematomas. This clinical study supports laboratory studies suggesting the usefulness of monitoring differential VCO2 to assess effective differential pulmonary perfusion during DLV.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00257460
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