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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 21 (1995), S. 475-481 
    ISSN: 1432-1238
    Keywords: Tracheostomy ; Methods ; ICU ; Postoperative complications ; Follow-up studies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective Percutaneous dilatational tracheostomy is increasingly practiced in intensive care units and has a low incidence of early complications. The late effects of this procedure are still poorly known and were the focus of this study. Design Prospective descriptive clinical study. Setting Interdisciplinary intensive care unit in a 300-bed teaching hospital. Patients A consecutive group of critically ill patients who underwent percutaneous tracheostomy between Nov. 90 and March 93, surviving at least 2 months after decannulation. Measurements and results There were 17 patients fulfilling the inclusion criteria and 16 of them were seen and examined. The follow-up protocol required a formal standar dized patient interview, a physical examination of the stoma site and a fiberoptic laryngotracheoscopy. Results of these sub-tests and overall outcome rating were standardized and expressed as good, moderate or poor. Subjective rating was good in all patients. All denied suffering from any side effects of their tracheostomy. Clinical examination revealed neither stridor nor hoarseness in any of the patients. Most of the scars were whitish and less than 1 cm in length, a few were sunken in, none had adhesions. In 15 patients the clinical result was good and in one, moderate (whitish, sunken-in scar, longer than 2 cm). Ten patients underwent tracheoscopy, while 6 did not. There were no signs of significant stenosis or tracheomalacia. In 8 patients with minor findings results were scored as good, while 2 were classified as moderate (combination of swelling and scar formation of a string-like membrane). The overall rating was good in 13 patients (81%) and moderate in 3 patients (19%). There were no poor outcomes. Conclusions Late outcome of percutaneous dilatational tracheostomy in critically ill patients is mostly good. Pending further studies, the use of this technique in intensive care units appears justified.
    Type of Medium: Electronic Resource
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  • 2
    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
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  • 3
    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
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  • 4
    ISSN: 1432-1238
    Keywords: Key words Colonic pseudo-obstruction ; Ogilvie disease ; Clonidine ; Alcohol-withdrawal delirium ; Case report
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We describe two cases of severe colonic pseudo-obstruction (Ogilvie's Syndrome) after high dose clonidine i. v. infusions for delirium tremens. The first symptoms occurred 36 h and 5 days, respectively, after institution of therapy. The diagnosis of colonic pseudo-obstruction (CPO) was confirmed during emergency laparotomy in both cases. While other known risk factors may have been present, we propose that clonidine had a major parasympatholytic effect on the large bowel of these patients and was therefore responsible, either alone or in combination with these other factors, for the development of CPO. We conclude that the therapy of delirium tremens with high i. v. doses of clonidine carries the risk of provoking severe CPO, especially when other contributing factors are present. While therapy of the alcohol withdrawal syndrome with clonidine appears to be an attractive alternative to conventional treatment, ICU physicians should be alerted to this potentially serious complication.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Freshwater biology 30 (1993), S. 0 
    ISSN: 1365-2427
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Biology
    Notes: 〈list xml:id="l1" style="custom"〉1 FST hemispheres have been proposed as a method for assessing flow characteristics near the river bottom. We suspected that the hemispheres were too big for this goai and that the ground plate would significantly affect near-bottom microhydraulics.2 The results we present have confirmed our assumption about the limitations of this method: the correlation between FST results and current velocity (measured by an anemometer, φ= 1.2cm) was best at 40% of depth (‘mean current velocity’, coefficient of determination r2= 0,58) and decreased to r2= 0.24 at 0.6 cm above the bottom; the correlation with (calculated) shear stress was only r2= 0.23. A correlation between FST results and macroinvertebrate abundance was found for only four of eight investigated taxa and was similar to the correlation between abundance and ‘mean current velocity’.3 We conclude that for fieldwork the FST hemispheres have about the same limitations as has a conventional (i.e. propeller-type) anemometer. With the hemispheres we could not obtain better data than with other methods.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Freshwater biology 30 (1993), S. 0 
    ISSN: 1365-2427
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Biology
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 16 (1992), S. 1124-1125 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 19 (1993), S. 209-214 
    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
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 24 (1998), S. 860-863 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1573-5117
    Keywords: stream assessment ; ecological integrity ; restoration ; rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract There is a difficult polarity between reality and ecologically desirable goals of stream ecosystem management in Switzerland. Most streams are exposed to a variety of impacts. Due to a high intensity of anthropogenic activity there is a high pressure on land and water use. Essential water uses have to be guaranteed. On the other hand there is also a strong need to preserve or restore (bring back ecological integrity) or rehabilitate streams (bring back `relative ecological integrity'). Stream assessment should, therefore, produce sound data suitable for characterizing the ecological condition of streams and for supporting their sustainable management. The methods should include a system approach as the basic unit and sound scientific principles of ecological integrity emphasizing habitat connectivities. The methods should allow: • the condition of streams to be rationally described and judged • identification of different kind of impacts on a stream • verification of the effects of water protection measures • identification of suitable future actions in the context of a whole stream system. In order to cover the various requirements a modular concept for stream system-oriented analysis was developed. Altogether nine modules are elaborated. Each module deals with specific stream features (two hydrodynamic and ecomorphological modules, five biological modules, two chemical and ecotoxicological modules). Single modules, several modules, or all of them may be applied, depending on the purpose of the analysis. For each module a cost-effective survey procedure (rapid method) and a progressively more rigorous method providing more detailed information is suggested. Based on the result of the analysis, stream rehabilitation concepts can then be elaborated in cooperation with managers, river engineers and biologists.
    Type of Medium: Electronic Resource
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