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  • 1
    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
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 25 (1999), S. 674-679 
    ISSN: 1432-1238
    Keywords: Key words Mechanical ventilation ; Dead space ; Airway pressure ; Barotrauma ; Tracheal gas insufflation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Aspiration of dead space (ASPIDS) improves carbon dioxide (CO2) elimination by replacing dead space air rich in CO2 with fresh gas during expiration. The hypothesis was that ASPIDS allows normocapnia to be maintained at low tidal volumes (VT). Design: Prospective study. Setting: Adult intensive care unit in a university hospital. Patients: Seven patients ventilated for neurological reasons were studied. All patients were clinically and haemodynamically stable and monitored according to clinical needs. Interventions: ASPIDS implies that, during expiration, gas is aspirated through a catheter inserted in the tracheal tube. Simultaneously, a compensatory flow of fresh gas is injected into the inspiratory line. ASPIDS was achieved with a computer/ventilator system controlling two solenoid valves for aspiration and injection. Results: At the basal respiratory rate of 12.6 breaths min–1, with ASPIDS VT decreased from 602 to 456 ml, as did the airway pressures to a corresponding degree. PaCO2 and PaO2 remained stable. At a frequency of 20 breaths min–1, with ASPIDS VT was further reduced to 305 ml with preserved normocapnia. ASPIDS did not interfere with the positive end-expiratory pressure (PEEP) level. No intrinsic PEEP developed. All patients remained stable. No haemodynamic or other side effects of ASPIDS were noticed. Conclusion: The results of this study suggest that ASPIDS may be a useful and safe modality of mechanical ventilation that limits alveolar pressure and minute ventilation requirements while keeping PaCO2 constant.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 21 (1995), S. 286-286 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1238
    Keywords: Key words Acute respiratory distress syndrome ; Static pressure volume curve ; Static compliance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the safety and the bedside feasibility of a new computerised method to record the static pressure-volume curves (Pst/V) of the respiratory system.¶Design: The Pst/V curves were recorded in 13 medical patients with the acute respiratory distress syndrome (ARDS). During the Pst/V curve tracing the following parameters were recorded: time required for the recording and the automatic analysis of the Pst/V curve and modifications in electrocardiograms, blood pressure, and arterial oxygen satmation (SaO2).¶Setting: The study was performed in the intensive care unit of the University of Naples “Federico II”.¶Results: No statistically significant modifications in heart rate (HR, b min–1), blood pressure (BP, mmHg), and SaO2 were observed between conditions at baseline (HR 97.2 ± 17.7; BP 65.4 ± 9.3; SaO2 93.6 ± 2.0), during the recording (HR 99.8 ± 19.5; BP 66.2 ± 11.6; SaO2 93.7 ± 2.4), and 2 min after the procedure (HR 98.2 ± 17.8; BP 65.2 ± 11.7; SaO2 93.7 ± 1.9). The Pst/V curves were recorded in 8.38 ± 1.19 min and fully analysed in 2.69 ± 0.85 min. Mean value of static compliance was 41.1 ± 12.7 ml cmH2O–1. A lower inflection point was found in ten patients (mean value 9.2 ± 1.9 cmH2O).¶Conclusions: In ARDS patients, the present new computerised method gave valuable data to ordinary intensivists and was shown to be safe, easy, and fast.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Infection 5 (1977), S. 95-97 
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Zwei Patienten mit einer fulminanten Lebernekrose, die sich im Koma Stadium IV befanden, wurden mit einer schnellen Infusion einer gekühlten, gepufferten Albumin-Elektrolytlösung und gleichzeitigen Ganzkörper-Spülung behandelt, um die zirkulierenden Neurotoxine zu entfernen und zusätzlich Zeit für die Leberregeneration zu gewinnen. Nach der Behandlung erwachten beide Patienten aus dem Koma. Ein Patient erholte sich vollständig, der andere starb am zweiten Tag an den Folgen einer massiven Magen-Darm-Blutung. Die klinische Bedeutung und die technischen Probleme des Verfahrens werden untersucht.
    Notes: Summary Two patients with fulminant hepatic necrosis and in stage IV coma were treated with a rapid infusion of refrigerated buffered albumin electrolyte solution combined with simultaneous total body wash-out in order to remove the circulating neurotoxins and to provide additional time for liver regeneration. Both patients awoke from the coma following treatment. One patient recovered completely, the other died on the second day as a result of massive gastro-intestinal bleeding. The clinical value and the technical problems of the procedure are investigated.
    Type of Medium: Electronic Resource
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