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  • 1
    Electronic Resource
    Electronic Resource
    Effects of ventilation in ventral decubitus position on respiratory mechanics in adult respiratory distress syndrome (1997)
    Springer
    Intensive care medicine 23 (1997), S. 1219-1224 
    Details
    ISSN: 1432-1238
    Keywords: Key words Acute respiratory failure ; Gas exchange ; Mechanics ; Body position ; Compliance of respiratory system ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the potential benefits of a period of ventilation in ventral decubitus (VD) on oxygenation and respiratory mechanics in the adult respiratory distress syndrome (ARDS). Design: In a stable condition during baseline ventilation in dorsal decubitus (DD), after 15 min of ventilation in VD and after 10 min of restored DD, the following parameters were studied: arterial blood gas tension, haemodynamics and static respiratory compliance (Crs), evaluated with the rapid airway occlusion technique. Setting: The study was completed in the intensive care units of university hospitals as part of the management of the patients studied. Patients: Twelve patients (7 males, 5 females, mean age 51.8 ± 16.6 years) suffering from ARDS of different aetiologies. Interventions: Before and during each evaluation, the patients were kept under stable haemodynamic and metabolic conditions. The ventilatory setting was kept constant. All the patients were sedated, paralysed and mechanically ventilated. Results: A statistically significant increase in the ratio between the arterial partial pressure of oxygen and fractional inspired oxygen (p 〈 0.01) was observed between the baseline conditions (mean 123.9 ± 22.6) and VD (mean 153.0 ± 16.9), while no statistical significance was noted between baseline conditions and after 10 min of restored DD (mean 141.1 ± 19.7). A significant increase in Crs (p 〈 0.001) was observed between baseline conditions (mean 42 ± 10.1) and VD (mean 48.8 ± 9.6) and between baseline conditions and restored DD (mean 44.7 ± 10.6). Two patients were considered non-responders. All the patients were haemodynamically stable. No side effects were noted. Conclusions: We observed an increase in oxygenation and Crs when the patients were turned from the supine to the prone position with the upper thorax and pelvis supported.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050489
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  • 2
    Electronic Resource
    Electronic Resource
    Continuous tracheal gas insufflation enables a volume reduction strategy in hyaline membrane disease: technical aspects and clinical results (1998)
    Springer
    Intensive care medicine 24 (1998), S. 1076-1082 
    Details
    ISSN: 1432-1238
    Keywords: Key words Mechanical ventilation ; Newborns ; Very-low-birthweight ; Dead space washout ; Barotrauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Instrumental dead space wash-out can be used to improve carbon dioxide clearance. The aim of this study was to define, using a bench test, an optimal protocol for long-term use, and to assess the efficacy of this technique in neonates. Design: A bench test with an artificial lung model, and an observational prospective study. Dead space wash-out was performed by continuous tracheal gas insufflation (CTGI), via six capillaries molded in the wall of a specially designed endotracheal tube, in 30 preterm neonates with hyaline membrane disease. Setting: Neonatal intensive care unit of a regional hospital. Results: The bench test study showed that a CTGI flow of 0.5 l/min had the optimal efficacy-to-side-effect ratio, resulting in a maximal or submaximal efficacy (93 to 100 %) without a marked increase in tracheal and CTGI circuit pressures. In the 30 newborns, 15 min of CTGI induced a significant fall in arterial carbon dioxide tension (PaCO2), from 45 ± 7 to 35 ± 5 mmHg (p = 0.0001), and in 14 patients allowed a reduction in the gradient between Peack inspirating pressure and positive end-expiratory pressure from 20.8 ± 4.6 to 14.4 ± 3.7 cmH2O (p 〈 0.0001) while keeping the transcutaneous partial pressure of carbon dioxide constant. As predicted by the bench test, the decrease in PaCO2 induced by CTGI correlated well with PaCO2 values before CTGI (r = 0.58, p 〈 0.002) and with instrumental dead space-to-tidal volume ratio (r = 0.54, p 〈 0.005). Conclusion: CTGI may be a useful adjunct to conventional ventilation in preterm neonates with respiratory disease, enabling an increase in CO2 clearance or a reduction in ventilatory pressure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050719
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  • 3
    Electronic Resource
    Electronic Resource
    Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients (1999)
    Springer
    Intensive care medicine 25 (1999), S. 920-929 
    Details
    ISSN: 1432-1238
    Keywords: Key words Acute lung injury ; Acute respiratory distress syndrome ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the prevalence and outcome of the acute respiratory distress syndrome (ARDS) among patients requiring mechanical ventilation. Design: A prospective, multi-institutional, initial cohort study including 28-day follow-up. Settings: Thirty-six French intensive care units (ICUs) from a working group of the French Intensive Care Society (SRLF). Patients: All the patients entering the ICUs during a 14-day period were screened prospectively. Hypoxemic patients, defined as having a PaO2/FIO2 ratio (P/F) of 300 mmHg or less and receiving mechanical ventilation, were classified into three groups, according to the Consensus Conference on ARDS: group 1 refers to ARDS (P/F: 200 mmHg or less and bilateral infiltrates on the chest X-ray); group 2 to acute lung injury (ALI) without having criteria for ARDS (200 〈 P/F ≤ 300 mmHg and bilateral infiltrates) and group 3 to patients with P/F of 300 mmHg or less but having exclusion criteria from the previous groups. Results: Nine hundred seventy-six patients entered the ICUs during the study period, 43 % of them being mechanically ventilated and 213 (22 %) meeting the criteria for one of the three groups. Among all the ICU admissions, ARDS, ALI and group 3 patients amounted, respectively, to 6.9 % (67), 1.8 % (17) and 13.3 % (129) of the patients, and represented 31.5 %, 8.1 % and 60.2 % of the hypoxemic, ventilated patients. The overall mortality rate was 41 % and was significantly higher in ARDS patients than in the others (60 % vs 31 % p 〈 0.01). In group 3, 42 patients had P/F less than 200 mmHg associated with unilateral lung injury; mortality was significantly lower (40.5 %) than in the ARDS group. In the whole group of hypoxemic, ventilated patients, septic shock and severity indices but not oxygenation indices were significantly associated with mortality, while the association with immunosuppression revealed only a trend (p = 0.06). Conclusions: In this survey we found that very few patients fulfilled the ALI non-ARDS criteria and that the mortality of the group with ARDS was high.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050983
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  • 4
    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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  • 5
    Electronic Resource
    Electronic Resource
    Clinical evaluation of a continuous intra-arterial blood gas system in critically ill patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1162-1168 
    Details
    ISSN: 1432-1238
    Keywords: Key words Blood gas monitor ; Critical care ; Equipment ; Acute respiratory distress syndrome ; Hypotension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the clinical performance of a new, continuous intra-arterial blood gas monitoring system (CIABG) in abnormal ranges of blood gases, and during episodes of low blood pressure, in critically ill patients. Design: Prospective study. Settings: Medical ICU, University Hospital. Methods: The CIABG system, based on fluorescent dyes, consists of a fiber-optic sensor introduced through an arterial catheter. Twenty-one sensors were evaluated in 15 acutely ill patients. A high failure rate (6/21) was found, due to the brittleness of the fibers. The bias, between CIABG and standard method, and precision were determined for each fiber and for the overall values. Analysis focused on the data collected in patients with arterial oxygen tension (PaO2) values below 75 mmHg, pH lower than 7.35 and arterial carbon dioxide partial pressure (PaCO2) values exceeding 50 mmHg and during episodes of low blood pressure. The accuracy of the CIABG to follow sequential changes in blood gases was studied among the abnormal values. Results: Measurements with CIABG among the abnormal values showed biases of +2 mmHg, +0.1 mmHg and +0.005 for PaO2, PaCO2 and pH, respectively, and precisions of 9.0 mmHg, 3.5 mmHg and 0.027, respectively. Bias and precision were not influenced by hemodynamic instability. A substantial difference in the performance of individual CIABG was observed for PaO2 analysis, with 30% of the fibers having a much poorer performance than the others. The sensors were kept in place for 5±2 days and the drift rate per day was 0.005 for pH, 0.6 mmHg for PaCO2 and –1.2 mmHg for PaO2. Conclusion: In situations of severe hypoxemia, hypercapnia and acidosis, the agreement between CIABG and arterial blood sampling (ABS) is better for PaCO2 and pH than for PaO2, and is not influenced by episodes of low blood pressure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709330
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  • 6
    Electronic Resource
    Electronic Resource
    Pressure-support ventilation: Still a simple mode? (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1137-1138 
    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/BF01709324
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  • 7
    Electronic Resource
    Electronic Resource
    Clinical evaluation of a continuous intra-arterial blood gas system in critically ill patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1162-1168 
    Details
    ISSN: 1432-1238
    Keywords: Blood gas monitor ; Critical care ; Equipment ; Acute respiratory distress syndrome ; Hypotension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the clinical performance of a new, continuous intra-arterial blood gas monitoring system (CIABG) in abnormal ranges of blood gases, and during episodes of low blood pressure, in critically ill patients. Design Prospective study. Settings Medical ICU, University Hospital. Methods The CIABG system, based on fluorescent dyes, consists of a fiber-optic sensor introduced through an arterial catheter. Twenty-one sensors were evaluated in 15 acutely ill patients. A high failure rate (6/21) was found, due to the brittleness of the fibers. The bias, between CIABG and standard method, and precision were determined for each fiber and for the overall values. Analysis focused on the data collected in patients with arterial oxygen tension (PaO2) values below 75 mmHg, pH lower than 7.35 and arterial carbon dioxide partial pressure (PaCO2) values exceeding 50 mmHg and during episodes of low blood pressure. The accuracy of the CIABG to follow sequential changes in blood gases was studied among the abnormal values. Results Measurements with CIABG among the abnormal values showed biases of +2 mmHg, +0.1 mmHg and +0.005 for PaO2, PaCO2 and pH, respectively, and precisions of 9.0 mmHg, 3.5 mmHg and 0.027, respectively. Bias and precision were not influenced by hemodynamic instability. A substantial difference in the performance of individual CIABG was observed for PaO2 analysis, with 30% of the fibers having a much poorer performance than the others. The sensors were kept in place for 5±2 days and the drift rate per day was 0.005 for pH, 0.6 mmHg for PaCO2 and −1.2 mmHg for PaO2. Conclusion In situations of severe hypoxemia, hypercapnia and acidosis, the agreement between CIABG and arterial blood sampling (ABS) is better for PaCO2 and pH than for PaO2, and is not influenced by episodes of low blood pressure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709330
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  • 8
    Electronic Resource
    Electronic Resource
    Intrapleural administration of streptokinase in complicated purulent pleural effusion: a CT-guided strategy (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1351-1353 
    Details
    ISSN: 1432-1238
    Keywords: Key words Empyema ; Pleural ; Computed tomography scan ; Fibrinolytics ; Streptokinase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To determine the usefulness and the results of a strategy using intrapleural streptokinase (SK) instillation guided by repeated computed tomography (CT) scan examinations in pleural empyemas unresponsive to chest tube drainage. Design: A retrospective chart review. Setting: The medical Intensive Care Unit and Department of Radiology, in a university hospital. Patients: Sixteen patients with empyema who had a persistent pleural effusion despite drainage, among 37 patients with infectious pleural effusion. Interventions: In the 16 patients, CT examination was performed before and at least once after SK. Intrapleural SK was instilled, either through the chest tube or via a needle puncture, according to the CT scan results. Results: The first CT scan confirmed a persistent effusion in all, showing a multiloculated effusion in 13 patients, and an ectopic loculus in one. The first SK instillation resulted in a dramatic increase of fluid drained per day (from 68±28 ml to 567±262 ml; p〈0.001), leading to complete resolution in 11 patients, while the others required a second CT scan-guided procedure. In one, the chest tube was misplaced, while in two, transparietal injection was needed. Finally, a complete resolution was observed in 14 (87.5%) of the patients. Two patients had a poor initial response to SK and were eventually scheduled for video-thoracoscopy. A single episode of chills and fever was observed among 32 SK instillations. Conclusion: CT-guided SK instillation in pleural empyema appears to be safe, and allowed complete resolution in 87.5% of our patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709550
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  • 9
    Electronic Resource
    Electronic Resource
    Intrapleural administration of streptokinase in complicated purulent pleural effusion: A CT-guided strategy (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1351-1353 
    Details
    ISSN: 1432-1238
    Keywords: Empyema ; Pleural ; Computed tomography scan ; Fibrinolytics ; Streptokinase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To determine the usefulness and the results of a strategy using intrapleural streptokinase (SK) instillation guided by repeated computed tomography (CT) scan examinations in pleural empyemas unresponsive to chest tube drainage. Design A retrospective chart review. Setting The medical Intensive Care Unit and Department of Radiology, in a university hospital. Patients Sixteen patients with empyema who had a persistent pleural effusion despite drainage, among 37 patients with infectious pleural effusion. Interventions In the 16 patients, CT examination was performed before and at least once after SK. Intrapleural SK was instilled, either through the chest tube or via a needle puncture, according to the CT scan, results. Results The first CT scan confirmed a persistent effusion in all, showing a multiloculated effusion in 13 patients, and an ectopic loculus in one. The first SK instillation resulted in a dramatic increase of fluid drained per day (from 68±28 ml to 567±262 ml;p〈0.001), leading to complete resolution in 11 patients, while the others required a second CT scanguided procedure. In one, the chest tube was misplaced, while in two, transparietal injection was needed. Finally, a complete resolution was observed in 14 (87.5%) of the patients. Two patients had a poor initial response to SK and were eventually scheduled for video-thoracoscopy. A single episode of chills and fever was observed among 32 SK instillations. Conclusion CT-guided SK instillation in pleural empyema appears to be safe, and allowed complete resolution in 87.5% of our patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709550
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  • 10
    Electronic Resource
    Electronic Resource
    Pressure-support ventilation: still a simple mode? (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1137-1138 
    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/BF01709324
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
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