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  • 1
    Electronic Resource
    Electronic Resource
    The automatic selection of ventilation parameters during the initial phase of mechanical ventilation (1996)
    Springer
    Intensive care medicine 22 (1996), S. 199-207 
    Details
    ISSN: 1432-1238
    Keywords: Closed-loop controlled ventilation ; Human ; Initial settings ; Computer ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To test a method that allows automatic set-up of the ventilator controls at the onset of ventilation. Design Prospective randomized crossover study. Setting ICUs in one adult and one children's hospital in Switzerland. Patients Thirty intubated stable, critically ill patients (20 adults and 10 children). Interventions The patients were ventilated during two 20-min periods using a modified Hamilton AMADEUS ventilator. During the control period the ventilator settings were chosen immediately prior to the study. During the other period individual settings were automatically determined by the ventilator (AutoInit). Measurements and results Pressure, flow, and instantaneous CO2 concentration were measured at the airway opening. From these measurements, series dead space (V DS), expiratory time constant (RC), tidal volume (V T), total respiratory frequency (f tot), minute ventilation (MV), and maximal and mean airway pressure (P aw, max andP aw, mean) were calculated. Arterial blood gases were analyzed at the end of each period.P aw, max was significantly less with the AutoInit ventilator settings whilef tot was significantly greater (P〈0.05). The other values were not statistically significant. Conclusions The AutoInit ventilator settings, which were automatically derived, were acceptable for all patients for a period of 20 min and were not found to be inferior to the control ventilator settings. This makes the AutoInit method potentially useful as an automatic startup procedure for mechanical ventilation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712237
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  • 2
    Electronic Resource
    Electronic Resource
    The automatic selection of ventilation parameters during the initial phase of mechanical ventilation (1996)
    Springer
    Intensive care medicine 22 (1996), S. 199-207 
    Details
    ISSN: 1432-1238
    Keywords: Key words Closed-loop controlled ventilation ; Human ; Initial settings ; Computer ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To test a method that allows automatic set-up of the ventilator controls at the onset of ventilation. Design: Prospective randomized crossover study. Setting: ICUs in one adult and one children’s hospital in Switzerland. Patients: Thirty intubated stable, critically ill patients (20 adults and 10 children). Interventions: The patients were ventilated during two 20-min periods using a modified Hamilton AMADEUS ventilator. During the control period the ventilator settings were chosen immediately prior to the study. During the other period individual settings were automatically determined by the ventilator (AutoInit). Measurements and results: Pressure, flow, and instantaneous CO2 concentration were measured at the airway opening. From these measurements, series dead space (V DS), expiratory time constant M28.6n(RC), tidal volume (V T), total respiratory frequency (f tot), minute ventilation (MV), and maximal and mean airway pressure (P aw,max and P aw,mean) were calculated. Arterial blood gases were analyzed at the end of each period. P aw,max was significantly less with the AutoInit ventilator settings while f tot was significantly greater (P〈0.05). The other values were not statistically significant. Conclusions: The AutoInit ventilator settings, which were automatically derived, were acceptable for all patients for a period of 20 min and were not found to be inferior to the control ventilator settings. This makes the AutoInit method potentially useful as an automatic start-up procedure for mechanical ventilation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712237
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    New aspects of pulmonary mechanics: “slowly” distensible compartments of the respiratory system, identified by a PEEP step maneuver (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1328-1334 
    Details
    ISSN: 1432-1238
    Keywords: Key words Acute respiratory distress syndrome (ARDS) ; Respiration ; artificial ; Respiratory system ; mechanics ; time constants ; Lung compliance ; Airway resistance ; Lung volume measurement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: The aims of the present study were 1) to evaluate a method for identification of “slowly” distensible compartments of the respiratory system (rs), which are characterized by long mechanical time constants (RC) and 2) to identify “slowly” distensible rs-compartments in mechanically ventilated patients. Design: Prospective study on a physical lung model. Setting: Intensive Care Unit, University Hospital, Tübingen Patients and participants: 19 patients with severe lung injury (acute respiratory distress syndrome, ARDS) and on 10 patients with mild lung injury. Measurements and results: Positive end-expiratory pressure (PEEP)-increasing and -decreasing steps of about 5 cmH2O were applied and the breath-by-breath differences of inspiratory and expiratory volumes (ΔV) were measured. The sequence of ΔVs were analyzed in terms of volume change in the “fast” compartment (Vfast), the “slow” compartment (Vslow), total change in lung volume (ΔVL) and mechanical time constant of the slow compartment (RCslow). Thirty-eight measurements in a lung model revealed a good correlation between the preset Vslow/ΔVL and Vslow/ΔVL measured: r2=0.91. 28.6nThe Vslow/ΔVL measured amounted to 0.94±0.15 of Vslow/ΔVL in the lung model. RCslow measured was 0.92±0.43 of the RCslow reference. Starting from a PEEP level of 11 cmH2O PEEP-increasing and PEEP-decreasing steps were applied to the mechanically ventilated patients. Three out of ten patients with mild lung injury (30%) and 7/19 patients with ARDS (36.8%) revealed “slowly” distensible rs-compartments in a PEEP-increasing step, whereas 15/19 ARDS patients and 1/10 patients with mild lung injury showed “slowly” distensible rs-compartments in a PEEP-decreasing step (78.9% vs 10%, P〈0.002, chi-square test). Conclusions: The gas distribution properties of the respiratory system can be easily studied by a PEEP-step maneuver. The relative contribution of the “slow” units to the total increase of lung volume following a PEEP step could be adequately assessed. “Slowly” distensible rs-compartments could be detected in patients with severe and mild lung injury, however significantly more ARDS patients revealed “slow” rs-compartments in PEEP-decreasing steps. The influence of “slowly” distensible rs-compartments on pulmonary gas exchange is unknown and has yet to be studied.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709546
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Respiratory mechanics by least squares fitting in mechanically ventilated patients: Applications during paralysis and during pressure support ventilation (1995)
    Springer
    Intensive care medicine 21 (1995), S. 406-413 
    Details
    ISSN: 1432-1238
    Keywords: Respiratory mechanics ; Respiratory resistance ; Respiratory compliance ; Mechanical ventilation ; Pressure support ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate a least squares fitting technique for the purpose of measuring total respiratory compliance (Crs) and resistance (Rrs) in patients submitted to partial ventilatory support, without the need for esophageal pressure measurement. Design Prospective, randomized study. Setting A general ICU of a University Hospital. Patients 11 patients in acute respiratory failure, intubated and assisted by pressure support ventilation (PSV). Interventions Patients were ventilated at 4 different levels of pressure support. At the end of the study, they were paralyzed for diagnostic reasons and submitted to volume controlled ventilation (CMV). Measurements and results A least squares fitting (LSF) method was applied to measure Crs and Rrs at different levels of pressure support as well as in CMV. Crs and Rrs calculated by the LSF method were compared to reference values which were obtained in PSV by measurement of esophageal pressure, and in CMV by the application of the constant flow, end-inspiratory occlusion method. Inspiratory activity was measured by P0.1. In CMV, Crs and Rrs measured by the LSF method are close to quasistatic compliance (−1.5±1.5 ml/cmH2O) and to the mean value of minimum and maximum end-inspiratory resistance (+0.9±2.5 cmH2O/(l/s)). Applied during PSV, the LSF method leads to gross underestimation of Rrs (−10.4±2.3 cmH2O/(l/s)) and overestimation of Crs (+35.2±33 ml/cmH2O) whenever the set pressure support level is low and the activity of the respiratory muscles is high (P0.1 was 4.6±3.1 cmH2O). However, satisfactory estimations of Crs and Rrs by the LSF method were obtained at increased pressure support levels, resulting in a mean error of −0.4±6 ml/cmH2O and −2.8±1.5 cmH2O/(l/s), respectively. This condition was coincident with a P0.1 of 1.6±0.7 cmH2O. Conclusion The LSF method allows non-invasive evaluation of respiratory mechanics during PSV, provided that a near-relaxation condition is obtained by means of an adequately increased pressure support level. The measurement of P0.1 may be helpful for titrating the pressure support in order to obtain the condition of near-relaxation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01707409
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    New aspects of pulmonary mechanics: ‘slowly” distensible compartments of the respiratory system, identified by a PEEP step maneuver (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1328-1334 
    Details
    ISSN: 1432-1238
    Keywords: Acute respiratory distress syndrome (ARDS) ; Respiration, artificial ; Respiratory system, mechanis, time constants ; Lung compliance ; Airway resistance ; Lung volume measurement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective The aims of the present study were 1) to evaluate a method for identification of “slowly” distensible compartments of the respiratory system (rs), which are characterized by long mechanical time constants (RC) and 2) to identify “slowly” distensible rs-compartments in mechanically ventilated patients. Design Prospective studyon a physical lung model. Setting Intensive Care Unit, University Hospital, Tübingen. Patients and participants 19 patients with severe lung injury (acute respiratory distress syndrome, ARDS) and on 10 patients with mild lung injury. Measurements and results Positive end-expiratory pressure (PEEP)-increasing and-decreasing steps of about 5 cmH2O were applied and the breath-by-breath differences of inspiratory and expiratory volumes (ΔV) were measured. The sequence of ΔVs were analyzed in terms of volume change in the “fast” compartment (Vfast), the “slow” compartment (Vslow), total change in lung volume (ΔVL) and mechanical time constant of the slow compartment (RCslow). Thirty-eight measurements in a lung model revealed a good correlation between the preset Vslow/ΔVL and Vslow/ΔVL measured: r2=0.91 The Vslow/ΔVL measured amounted to 0.94±0.15 of Vslow/ΔVL in the lung model. RCslow measured was 0.92±0.43 of the RCslow reference. Starting from a PEEP level of 11 cmH2O PEEP-increasing and PEEP-decreasing steps were applied to the mechanically ventilated patients. Three out of ten patients with mild lung injury (30%) and 7/19 patients with ARDS (36.8%) revealed “slowly” distensible rscompartments in a PEEP-increasing step, whereas 15/19 ARDS patients and 1/10 patients with mild lung injury showed “slowly” distensible rs-compartments in a PEEP-decreasing step (78.9% vs 10%,P〈0.002, chi-square test). Conclusions The gas distribution properties of the respiratory system can be easily studied by a PEEP-step maneuver. The relative contribution of the “slow” units to the total increase of lung volume following a PEEP step could be adequately assessed. “Slowly” distensible rs-compartments could be detected in patients with severe and mild lung injury, however significantly more ARDS patients revealed “slow” rs-compartments in PEEP-decreasing steps. The influence of “slowly” distensible rs-compartments on pulmonary gas exchange is unknown and has yet to be studied.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709546
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    Paper (German National Licenses)
    Fulltext
  • 6
    Electronic Resource
    Electronic Resource
    Unfavorable mechanical effects of heat and moisture exchangers in ventilated patients (1997)
    Springer
    Intensive care medicine 23 (1997), S. 399-405 
    Details
    ISSN: 1432-1238
    Keywords: Key words Respiration ; artificial instrumentation ; Heat and moisture exchanger ; Respiratory mechanics ; Pressure support ventilation ; P0.1 ; Feedback control
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To investigate the mechanical effects of artificial noses. Setting: A general intensive care unit of a university hospital. Patients: 10 patients in pressure support ventilation for acute respir
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050347
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  • 7
    Electronic Resource
    Electronic Resource
    Computerized blood gas interpretation as tool for classroom and ICU (1993)
    Springer
    Intensive care medicine 19 (1993), S. 209-214 
    Details
    ISSN: 1432-1238
    Keywords: Arterial blood gas ; Computerized teaching ; Computerized interpretation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To describe structure and function of a PC based blood gas interpretation program (ABG-consultant) developed for nurses and physicians, and to test educational impact and user acceptance. Design Prospective, blinded study Setting Interdisciplinary ICU of a county hospital in Switzerland Participants Nurses specialized in intensive care Interentions Exposure to the ABG-consultant program Measurement and results A first group of nurses was subjected to a written examination, then the ABG-consultant was made available for them for 2 months, and finally the same examination was taken again. Additionally, they completed a questionnaire related to the performance of the ABG-consultant. A second group of nurses took the same sequence of examinations but had no access to the ABG-consultant. The score of the examinations increased by 4.8 points in the first group (p〈0.0001) and by 1.3 points (p〈0.16) in the second group. More than 400 consultations were conducted over a period of 2 months and the users themselves stated that the system was of help and easy to use. Conclusion The results have shown that exposure to the ABG-consultant has increased the blood gas knowledge of the ICU nurses. It therefore appears desirable and worthwhile to address other areas of clinical medicine by a similar teaching-consulting approach.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01694772
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  • 8
    Electronic Resource
    Electronic Resource
    Changes in pulmonary mechanics after fiberoptic bronchoalveolar lavage in mechanically ventilated patients (1998)
    Springer
    Intensive care medicine 24 (1998), S. 1289-1293 
    Details
    ISSN: 1432-1238
    Keywords: Key words BAL ; Bronchoalveolar lavage ; Pulmonary mechanics ; Pulmonary compliance ; Pulmonary resistance ; Mechanical ventilation ; Respiratory function ; Intensive care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: We prospectively assessed the impact of bronchoalveolar lavage (BAL) on respiratory mechanics in critically ill, mechanically ventilated patients. Study design: Mechanically ventilated patients underwent BAL of one lung segment using 5 × 20 ml of sterile, physiologic saline with a temperature of 25–28 °C. The fractional inspired oxygen was increased to 1.0, but ventilator settings were otherwise left unchanged. Static pulmonary compliance, pulmonary resistance, alveolar ventilation, and serial dead space were measured 60 min and 2 min before and 8, 60, and 180 min after BAL to assess the consequences of the procedure. In addition, blood gases [partial pressure of carbon dioxide in arterial blood (PaCO2) and arterial oxigen tension (PaO2)], hemodynamic variables (heart rate, systolic and diastolic blood pressure), and body temperature were recorded at the same time points. Setting: Intensive care unit of a university hospital. Patients: 18 consecutive critically ill, mechanically ventilated patients. Results: Pulmonary compliance decreased by 23 % (p 〈 0.05) and pulmonary resistance increased by 22 % (p 〈 0.05) shortly after BAL. The changes in pulmonary compliance and resistance were more than 30 % in one third of the patient population. One hour after the procedure, PaO2 was significantly lower and PaCO2 significantly higher than before the procedure. Three hours after the procedure, pulmonary resistance returned to pre-BAL values but compliance remained 10 % below baseline values (p 〈 0.05). Conclusion: BAL in mechanically ventilated patients is associated with deterioration of pulmonary mechanics and function.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050764
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  • 9
    Electronic Resource
    Electronic Resource
    A simple method to estimate functional residual capacity in mechanically ventilated patients (1993)
    Springer
    Intensive care medicine 19 (1993), S. 372-376 
    Details
    ISSN: 1432-1238
    Keywords: Mechanical ventilation ; Respiration ; Functional residual capacity ; Lung volume
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective The aim of the present study was to evaluate a simplified method for FRC measurement.Design: Accuracy and precision of the method were assessed in a physical lung model; reproducibility was tested in 10 mechanically ventilated patients. In each patient FRC was measured at three PEEP levels.Setting: Post-operative intensive care unit in a university hospital. Measurements and results Gas flow, CO2 concentration, and O2 concentration were measured during in- and expiration by pneumotachography, a mainstream capnometer and a sidertream O2-analyser. For FRC-measurement inspiratory O2 concentration was changed by 30%. FRC was determined as mean value of a N2 washout and N2 washin procedure. Evaluation of this method in a lung model shows a good correlation between FRC set in the lung model and FRC measured (FRC measured =1.028*FRC model+22.92 ml;r 2=0.957;n=30). The mean difference was 4.4% of FRC-reference (range −8.4% to +21.7%). Duplicate determinations in 10 mechanically ventilated patients differed by an average of −2.7% (range −30.1% to +27.3%). Conclusion Our results suggest that the proposed method can be used in daily clinical work.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01724875
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