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  • 1
    Electronic Resource
    Electronic Resource
    State of the art: critical care (2004)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 59 (2004), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.2004.03764.x
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  • 2
    Electronic Resource
    Electronic Resource
    The peri-operative management of surgical insertion and removal of the intravenous oxygenator device (IVOX) (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 48 (1993), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Intravenous oxygenation (IVOX) is a new technique for augmentation of gas exchange in patients who require near maximal conventional ventilatory support. Patients who require IVOX are, by definition, critically ill with a high expected mortality. At present, these high risk patients must be transferred to the operating theatre for the IVOX device to be inserted. This report describes the anaesthetic problems associated with nine patients in whom an IVOX device was inserted and removed in our institution. The mortality was six out of nine patients; all deaths occurred with the IVOX device in situ. Three patients died within 6 h of insertion. Four patients were female. The patients' ages ranged from 14 to 76 years. There were few immediate ventilation changes in the first 4 h after IVOX insertion. Inspired oxygenation concentration was reduced in only one patient. Positive end-expiratory pressure was not reduced. Peak inspiratory pressure decreased in four patients. Arterial oxygen tension increased in four patients (range 0.1–2.5 kPa) and decreased in five (range 0.1–3.4 kPa). Arterial carbon dioxide tension increased in one patient (0.3 kPa) and decreased in eight (range 0.1–2.7 kPa). Inotropic support with adrenaline, dobutamine and nor adrenaline needed to be initiated or increased in eight patients. Eight patients required 2–4 units of blood to be transfused during IVOX insertion or in the following 2 h. One patient suffered an asystolic cardiac arrest during the operation, but was resuscitated successfully. Three patients survived to have the IVOX removed. There were no cardiorespiratory problems associated with its removal and although all three required a vein patch to repair the venotomy site, no patient required blood transfusion. We conclude that IVOX insertion (including transfer to and from the operating theatre) represents a significant cardiorespiratory insult to these critically ill patients. Anaesthetic staff need to be aware of the potential problems to enable them to minimise the risk of serious complications during the insertion of this novel device.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1993.tb07411.x
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  • 3
    Electronic Resource
    Electronic Resource
    External high frequency oscillation in normal subjects and in patients with acute respiratory failure (1995)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 50 (1995), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: External high frequency oscillation was performed on 20 healthy volunteers using a cuirass-based system, the Hayek Oscillator. Five-min periods of oscillation were carried out on each subject at frequencies of 1, 2, 3, 4 and 5 Hz. Effective ventilation was measured in terms of the fall in alveolar partial pressure of carbon dioxide immediately after oscillation. The optimum frequency for oscillation was 1–3 Hz but most of the subjects were adequately ventilated over a wide range of frequencies. Thus, the Hayek Oscillator is capable of adequately ventilating normal subjects by means of chest wall oscillation. We also compared external high frequency oscillation with intermittent positive pressure ventilation in five patients with respiratory failure. Using the same inspired oxygen fraction, the external high frequency oscillation replaced intermittent positive pressure ventilation for a 30-min period. External high frequency oscillation improved oxygenation by 16% and reduced the arterial carbon dioxide by 6%. These preliminary findings suggest that normal subjects and intensive care unit patients can be adequately ventilated by means of external high frequency oscillation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1995.tb05945.x
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  • 4
    Electronic Resource
    Electronic Resource
    Isoflurane and propofol for long-term sedation in the intensive care unit (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 47 (1992), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Propofol and isoflurane have been reported recently to offer better sedation than alternative agents in patients who require long-term ventilation in the Intensive Care Unit. This is the first report of a direct comparison between propofol and isoflurane. Twenty-four patients predicted to require artificial ventilation for at least 48 h were entered into a randomised crossover study to monitor sedation quality and time to recovery from sedation. There were no significant differences between the two agents in either end-point, with over 95% optimal sedation achieved by the use of each drug. Few adverse events were noted. Technological advances in the administration of volatile agents as long-term sedatives in the Intensive Care Unit may facilitate their more widespread use.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1992.tb03254.x
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  • 5
    Electronic Resource
    Electronic Resource
    Acid−base physiology: the ‘traditional’ and the ‘modern’ approaches (2002)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary The interpretation and understanding of acid–base dysfunction has recently been revisited. The ‘traditional’ approach developed from the pioneering work of Henderson and Hasselbalch and is still the most widely used in clinical practice. There are a number of problems identified with this approach, however. The ‘modern’ approach derives from Stewart's work in physical chemistry. In this review we describe the origins of the traditional approach and discusses related concepts. We then describe Stewart's approach, including how it is derived and how it may be used to classify acid–base derangements. The applications of Stewart's approach to clinical scenarios in intensive care is then discussed briefly before we examine some published clinical studies based on his work.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.0003-2409.2001.02447.x
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  • 6
    Electronic Resource
    Electronic Resource
    Tracheal dilatation complicating prolonged tracheal intubation (1997)
    Oxford : Blackwell Science Ltd
    Anaesthesia 52 (1997), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A patient with severe acute respiratory distress syndrome requiring prolonged tracheal intubation and mechanical ventilation is described. Tracheal dilatation was noted to have occurred following an elective surgical tracheostomy. Eventually, the patient was successfully weaned from mechanical ventilation and the tracheostomy tube removed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1997.t01-3-010-az010.x
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  • 7
    Electronic Resource
    Electronic Resource
    A haemodynamic and pharmacokinetic study to assess a new transdermal nitroglycerin preparation in normal subjects (1984)
    Springer
    European journal of clinical pharmacology 26 (1984), S. 293-296 
    Details
    ISSN: 1432-1041
    Keywords: nitroglycerin ; transdermal application ; echocardiography ; plasma nitroglycerin levels ; normal subjects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary A continual application of a transdermal Nitroglycerin (Nitrodur) has been haemodynamically and pharmacokinetically assessed in a group of 10 normal healthy volunteers over a 24 h period. There were significant decreases in left ventricular end systolic dimension and end diastolic dimension over this period, demonstrating a continuous haemodynamic effect. A dose related response was not demonstrated, although low plasma nitroglycerin levels produced significant haemodynamic changes. The persistant decrease in left ventricular wall stress implies a reduction in myocardial oxygen consumption. Thus Nitrodur may play an important role in the long term prophylaxis of angina.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00548757
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  • 8
    Electronic Resource
    Electronic Resource
    Application of the medical anti-shock trouser (MAST) increases cardiac output and tissue perfusion in simulated, mild hypovolaemia (1986)
    Springer
    Intensive care medicine 12 (1986), S. 143-146 
    Details
    ISSN: 1432-1238
    Keywords: Medical anti-shock trouser (MAST) ; Hypovolaemia ; Cardiac output ; Arterial pressure ; Lower body positive pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We have studied the haemodynamic effects of the application of the medical anti-shock trouser (MAST) in 10 healthy subjects in the semi-upright position in order to simulate mild hypovolaemia. Left ventricular end diastolic dimension (EDD) was measured by M-mode echocardiography and cardiac output (CO) by the Doppler ultrasound technique. Forearm blood flow (FBF) was measured by plethysmography and blood pressure (BP) by the standard cuff technique. Systematic increases in MAST pressure of up to 80 mm Hg were applied. EDD increased to a maximum of 9.3% (p≤0.01) which was associated with a maximum increase in CO of 31.7% (p≤0.05). FBF increased by a maximum of 54.2% (p≤0.001) whilst BP increased by a maximum of 12% (p≤0.001). These results demonstrate that the application of the MAST is an effective means of transferring blood to the central circulation by compression of the capacitance vessels resulting in significant increases in cardiac output and tissue perfusion. At high pressures there was evidence of compression of resistance vessels, which may be useful in reducing blood loss. The ease and rapidity with which his suit can be applied suggests that it may be useful in the short term treatment of hypovolaemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00254929
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  • 9
    Electronic Resource
    Electronic Resource
    In vitro colloid osmotic pressure of commonly used plasma expanders and substitutes: a study of the diffusibility of colloid molecules (1989)
    Springer
    Intensive care medicine 15 (1989), S. 116-120 
    Details
    ISSN: 1432-1238
    Keywords: Colloid osmotic pressure ; Plasma substitutes-diffusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The rational choice of a plasma substitute for states of hypovolaemia depends partly on its colloid osmotic pressure (COP). We have measured the COP of 108 samples of plasma substitute across selectively permeable membranes which retain molecules greater than 10000 dalton (COP10) and 50000 dalton (COP50) the ratio COP50/COP10 providing a potential index of diffusibility of the smaller molecules across capillary membranes. 6% Hespan solution showed a particularly favourable COP50/COP10 ratio at 0.58 indicating a potential for good retention in the circulation whilst 3.5% Haemaccel showed a COP50/COP10 ratio of 0.18 indicating a potential for marked transcapillary diffusion, especially in states of capillary leak. In patients with normal capillary permeability both Gelofusine and Dextran 110 are likely to show adequate retention in the circulation with a COP50/COP10 ratio of 0.37 and 0.39 respectively. These are comparable to the retention of 4.5% human albumin (0.36) but all of the plasma substitutes tested, with the exception of Haemaccel, provided a higher COP across both membranes than 4.5% human albumin solution. An in vivo comparison of these plasma substitutes is required to confirm the advantages of macromolecular colloids in states of capillary leak.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00295988
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    Paper (German National Licenses)
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  • 10
    Electronic Resource
    Electronic Resource
    Changes in cardiac output during air ambulance repatriation (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1396-1399 
    Details
    ISSN: 1432-1238
    Keywords: Key words Air ambulance ; Cardiac output ; Ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives To measure, with the use of suprasternal Doppler ultrasound, the hemodynamic changes in patients and volunteers during air ambulance repatriation. Design: Unblinded prospective observational study. Setting: Chartered air ambulances for the international repatriation of patients. Patients and participants: Six medical crew members and seven patients transported back to hospitals in the UK. Interventions: The measurement of non-invasive blood pressure, ECG, heart rate, oxygen saturation and hemodynamic variables with suprasternal Doppler. Measurements and results: There was a drop in systolic and mean arterial blood pressure in the patient’s group once in the air. Oxygen saturation dropped in both groups once at cruising altitude. Heart rate remained unchanged. Stroke distance and minute distance increased significantly in the patient’s group and non-significantly in the volunteers. Peak velocity increased significantly in the patient’s group. There was an overall reduction of systemic vascular resistance during take off and once at cruising altitude. Conclusions: Hemodynamic changes happen during air ambulance transportation in fit and healthy volunteers and patients alike. These may be due to a combination of hypobaric hypoxia and gravitational forces. It is necessary to establish if these changes have short- or long-term effects in the critically ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709557
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