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  • 1
    Electronic Resource
    Electronic Resource
    Weaning and extubation in the intensive care unit (1996)
    Springer
    Intensive care medicine 22 (1996), S. 752-759 
    Details
    ISSN: 1432-1238
    Keywords: Weaning ; Extubation ; Indices ; Subjective ; Critically ill ; Mechanical ventilation ; CPAP ; Pressure support
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To assess the outcome of a clinical judgementbased approach to weaning and extubation and to adduce the predictive accuracy of various mechanical respiratory indices measured in parallel. Design Prospective study. Setting Multidisciplinary intensive care unit at a university teaching hospital. Patients 163 consecutive mechanically ventilated patients, excluding tracheotomy, for weaning trial and extubation. Interventions Using bedside clinical assessment, aided by arterial gas analysis, patients were weaned from mechanical ventilation to spontaneous ventilation via the continuous positive airway pressure (CPAP) circuit (with pressure support) of a microprocessor-controlled ventilator. Extubation occurred from the CPAP circuit at 7 cmH2O pressure support, fractional inspired oxygen (FIO2)≤0.5 and CPAP level of ≤5 cmH2O, such that the partial pressure of oxygen in arterial blood (PaO2) was ≥65 mmHg. Before extubation, observation for a 1-h (T0 and T60) trial period allowed measurement of vital capacity (VC), expired minute volume (VE), respiratory rate/tidal volume (f/VT) and maximal inspiratory pressure (MIP) using a one-way valve technique over 25 s. Measurements and main results Over 7 months, 163 patients (62 females and 101 males; mean(SD) age 64(15) years) were considered. There were 91 surgical (18 with chronic obstructive pulmonary disease; COPD) and 72 medical (28 with COPD) patients. Ventilation was for ≥1 day (median 5 days, range 1–31) in 115 [group I; APACHE II score 23(8)] and ≤1 day in 48 [Group II; APACHE II score 17(6)]. Three patients (all Group I: 2 surgical, 1 medical) were reintubated within 24 h, an overall extubation failure rate of 1.8%. In group I, at T0, PaO2/FIO2 was 238(65), f/VT 50(26), MIP 44(21) cmH2O, VE 10.6(3.7) l/min, VC 13(5) ml/kg. Cardiorespiratory variables did not change significantly in either group, T0 to T60. For prediction of reintubation (n=163), only VE (threshold 〉10 l/min) and f/VT (threshold 〉100) demonstrated moderate sensitivity and specificity at T60∶67 and 52% and 33 and 94%, respectively. Conclusions Bedside clinicla judgement of weaning and extubation produces satisfactory outcomes. As a routine, mechanical predictive indices have limited utility.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709517
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Inspiratory work imposed by continuous positive airway pressure (CPAP) machines: the effect of CPAP level and endotracheal tube size (1992)
    Springer
    Intensive care medicine 18 (1992), S. 148-154 
    Details
    ISSN: 1432-1238
    Keywords: Inspiratory work ; CPAP ; Inspiratory flow ; Endotracheal tube
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Inspiratory work imposed by Continuous Positive Airway Pressure (CPAP) machines has been a matter of concern. The imposed inspiratory work of CPAP machine circuits (Wcir) and the effect of the total breathing apparatus with endotracheal tube (ETT) and connector included in the circuit (Wapp), were measured in three continuous flow (CF) and various configurations of three demand flow (DF) CPAP machines. The performance was assessed at 0, 5, 10 and 15 cmH2O CPAP using a Michigan Instruments Test Lung Model 1600, internal compliance set at 50 ml/cmH2O, driven at square wave inspiratory flows ( $$\dot V$$ I) of 20, 40 and 60 l/min at a tidal volume of 500 ml. Work, expressed in mJ/l, was calculated from the area of pressure-volume loops. Inspiratory work, Wcir and Wapp, was dependent upon the particular CPAP machine, $$\dot V$$ I and ETT size, but not upon CPAP level, being maximum at $$\dot V$$ I 601/min and with ETT 7.0 mm i.d. Work values (Wcir) varied from 50 to 325 mJ/l with both CF and DF machines and up to 1100 mJ/l with ETT and connector (Wapp). No consistent advantage of CF over DF machines was demonstrated. There was little advantage of high gas flows (〉5 l/min) in various DF circuits. Within an individual machine maximum negative pressures generated during inspiration correlated with both Wcir and Wapp.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709238
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Weaning and extubation in the intensive care unit (1996)
    Springer
    Intensive care medicine 22 (1996), S. 752-759 
    Details
    ISSN: 1432-1238
    Keywords: Key words Weaning ; Extubation ; Indices ; Subjective ; Critically ill ; Mechanical ventilation ; CPAP ; Pressure support
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the outcome of a clinical judgement-based approach to weaning and extubation and to adduce the predictive accuracy of various mechanical respiratory indices measured in parallel. Design: Prospective study. Setting: Multidisciplinary intensive care unit at a university teaching hospital. Patients: 163 consecutive mechanically ventilated patients, excluding tracheotomy, for weaning trial and extubation. Interventions: Using bedside clinical assessment, aided by arterial gas analysis, patients were weaned from mechanical ventilation to spontaneous ventilation via the continuous positive airway pressure (CPAP) circuit (with pressure support) of a microprocessor-controlled ventilator. Extubation occurred from the CPAP circuit at 7 cmH2O pressure support, fractional inspired oxygen (FIO2) ≤0.5 and CPAP level of ≤5 cmH2O, such that the partial pressure of oxygen in arterial blood (PaO2) was ≥65 mmHg. Before extubation, observation for a 1-h (T0 and T60) trial period allowed measurement of vital capacity (VC), expired minute volume (VE), respiratory rate/tidal volume (f/VT) and maximal inspiratory pressure (MIP) using a one-way valve technique over 25 s. Measurements and main results: Over 7 months, 163 patients (62 females and 101 males; mean(SD) age 64(15) years) were considered. There were 91 surgical (18 with chronic obstructive pulmonary disease; COPD) and 72 medical (28 with COPD) patients. Ventilation was for ≥1 day (median 5 days, range 1–31) in 115 [group I; APACHE II score 23(8)] and ≤1 day in 48 [Group II; APACHE II score 17(6)]. Three patients (all Group I: 2 surgical, 1 medical) were reintubated within 24 h, an overall extubation failure rate of 1.8%. In group I, at T0, PaO2/FIO2 was 238(65), f/VT 50(26), MIP 44(21) cmH2O, VE 10.6(3.7) l/min, VC 13(5) ml/kg. Cardiorespiratory variables did not change significantly in either group, T0 to T60. For prediction of reintubation (n=163), only VE (threshold 〉10 l/min) and f/VT (threshold 〉 100) demonstrated moderate sensitivity and specificity at T60: 67 and 52% and 33 and 94%, respectively. Conclusions: Bedside clinical judgement of weaning and extubation produces satisfactory outcomes. As a routine, mechanical predictive indices have limited utility.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709517
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 4
    Electronic Resource
    Electronic Resource
    A high flow turbine CPAP system (1988)
    Springer
    Intensive care medicine 14 (1988), S. 658-660 
    Details
    ISSN: 1432-1238
    Keywords: CPAP ; Turbine ; High flow ; Work of breathing ; Mobile
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A continuous high flow CPAP system incorporating a turbine blower is described. The system achieves inspiratory flow rates of 150l/min or more by means of reticulated gas flow and inspired oxygen fractions of 0.21–0.95. Positive airway pressure is provided by weighted disc valves and a modified aviationtype CPAP face mask provides electronic communication with the patient. The mobility of the system also enables its use as an intermittent physiotherapy aid. Work of breathing of the system, as assessed by total pressure fluctuations, is at a minimum.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00256773
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Use of tricalcium phosphate or electrical stimulation to enhance the bone-porous implant interface (1986)
    Hoboken, NJ : Wiley-Blackwell
    Journal of Biomedical Materials Research 20 (1986), S. 65-77 
    Details
    ISSN: 0021-9304
    Keywords: Chemistry ; Polymer and Materials Science
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Medicine , Technology
    Notes: Implant stabilization by biologic ingrowth into a porous surface offers a durable method of prosthetic fixation. These systems, however, lack the immediate stability offered by the use of acrylic bone cement. The interface strength of porous coated Co—Cr—Mo in a canine model does not approach that of acrylic bone cement until two weeks postoperatively. It is expected that this would be a minimum time period in clinical applications. Both chemical and electrical means have been advocated as methods to affect tissue ingrowth. A study using a canine model was undertaken to determine tissue ingrowth rates utilizing examples of these two methods: (1) impregnation of the porous structures with tricalcium phosphate powder (TCP); or (2) the application of an electrical stimulator to the implant with the implant itself serving as the cathode. Ten implants were coated with TCP, two each at weekly intervals from 1 to 5 weeks. Plain porous rods were likewise implanted, serving as the controls. While histology did reveal a slightly more dense bony structure, the interface bond strength was not affected by TCP. Electrical stimulation of the implant was similarly investigated with an additional time period of 10 weeks. Compared to the controls, the electrically stimulated implants reveal no statistically demonstratable difference in interface strength. Histologic specimens indicate larger areas of calcification than are observed in the controls.
    Additional Material: 6 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/jbm.820200107
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    Paper (German National Licenses)
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  • 6
    Electronic Resource
    Electronic Resource
    The formation of stain on acrylic surfaces by the interaction of cationic antiseptic mouthwashes and tea (1984)
    Hoboken, NJ : Wiley-Blackwell
    Journal of Biomedical Materials Research 18 (1984), S. 631-641 
    Details
    ISSN: 0021-9304
    Keywords: Chemistry ; Polymer and Materials Science
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Medicine , Technology
    Notes: Clinical and in vitro studies have implicated dietary components as major aetiological factors in staining of teeth and acrylic materials associated with chlorhexidine use, a local side effect not unique to this antiseptic. These experiments studied the precipitation and surface staining reactions of the cationic antiseptics alexidine, cetyl pyridinium chloride (CPC), chlorhexidine, and hexetidine, with the beverage tea. All of the antiseptics precipitated a standard tea solution and for alexidine and chlorhexidine acetate and gluconate, this was at concentrations 〉100 μmol/L, for hexetidine 〉200 μmol/L, and for CPC 〉400 μmol/L. With the exception of CPC precipitation was reduced with decreasing pH and for chlorhexidine was inhibited below pH 3. The addition of polymethylmethacrylate (PMMA) to the antiseptic solutions increased the precipitation concentrations by an amount calculated to be adsorbed by polymer. Acrylic blocks treated with equimolar solutions of the antiseptics became progressively and significantly more stained by tea than control specimens over a 5-day period. Alexidine induced significantly greater staining and hexetidine significantly less than the other antiseptics. Staining was pH dependent and significantly reduced as the pH decreased. Both stain and precipitates were insoluble in strong acids and alkalis. It is concluded that staining observed clinically may represent a precipitation reaction with the complexing of antiseptics with dietary chromogenic material.
    Additional Material: 3 Ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1002/jbm.820180605
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    Paper (German National Licenses)
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