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  • 1
    Electronic Resource
    Electronic Resource
    Determination of functional residual capacity (FRC) by multibreath nitrogen washout in a lung model and in mechanically ventilated patients (1998)
    Springer
    Intensive care medicine 24 (1998), S. 487-493 
    Details
    ISSN: 1432-1238
    Keywords: Key words Aged ; Functional residual capacity ; Lung volume measurement ; Mechanical ventilation ; Critical care ; Chronic obstructive pulmonary disease ; Acute lung injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Validation of an open-circuit multibreath nitrogen washout technique (MBNW) for measurement of functional residual capacity (FRC). The accuracy of FRC measurement with and without continuous viscosity correction of mass spectrometer delay time (TD) relative to gas flow signal and the influence of baseline FIO2 was investigated. Design: Laboratory study and measurements in mechanically ventilated patients. Setting: Experimental laboratory and anesthesiological intensive care unit of a university hospital. Patients: 16 postoperative patients with normal pulmonary function (NORM), 8 patients with acute lung injury (ALI) and 6 patients with chronic obstructive pulmonary disease (COPD) were included. Interventions: Change of FIO2 from baseline to 1.0. Measurements and main results: FRC was determined by MBNW using continuous viscosity correction of TD (TDdyn), a constant TD based on the viscosity of a calibration gas mixture (TD0) and a constant TD referring to the mean viscosity between onset and end of MBNW (TDmean). Using TDdyn, the mean deviation between 15 measurements of three different lung model FRCs (FRCmeasured) and absolute volumes (FRCmodel) was 0.2 %. For baseline FIO2 ranging from 0.21 to 0.8, the mean deviation between FRCmeasured and FRCmodel was −0.8 %. However, depending on baseline FIO2, the calculation of FRC using TDmean and TD0 increased the mean deviation between FRCmeasured and FRCmodel to 2–4 % and 8–12 %, respectively. In patients (n = 30) the average repeatability coefficient was 6.0 %. FRC determinations with TDmean and TD0 were 0.8–13.3 % and 4.2–23.9 % (median 2.7 % and 8.7 %) smaller than those calculated with TDdyn. Conclusion: A dynamic viscosity correction of TD improves the accuracy of FRC determinations by MBNW considerably, when gas concentrations are measured in a sidestream. If dynamic TD correction cannot be performed, the use of constant TDmean might be suitable. However, in patient measurements this can cause an FRC underestimation of up to 13 %.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050601
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Proportional assist versus pressure support ventilation: effects on breathing pattern and respiratory work of patients with chronic obstructive pulmonary disease (1999)
    Springer
    Intensive care medicine 25 (1999), S. 790-798 
    Details
    ISSN: 1432-1238
    Keywords: Key words Mechanical ventilation ; Critical care ; Chronic obstructive pulmonary disease ; Patient-ventilator interaction ; Proportional assist ; Pressure support ; Work of breathing physiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To investigate the breathing pattern and the inspiratory work of breathing (WOBI) in patients with chronic obstructive pulmonary disease (COPD) assisted with proportional assist ventilation (PAV) and conventional pressure support ventilation (PSV). Design: Prospective controlled study. Setting: Intensive care unit of a university hospital. Patients: Thirteen COPD patients being weaned from mechanical ventilation. Interventions: All patients were breathing PSV and two different levels of PAV. Measurements and main results: During PAV (EVITA 2 prototype, Dräger, Germany), the resistance of the endotracheal tube (Ret) was completely compensated while the patients' resistive and elastic loads were compensated for by approximately 80 % and 50 % (PAV80 and PAV50), respectively. PSV was adjusted to match the same mean inspiratory pressure (Pinspmean) as during PAV80. Airway pressure, esophageal pressure and gas flow were measured over a period of 5 min during each mode. Neuromuscular drive (P0.1) was determined by inspiratory occlusions. Mean tidal volume (VT) was not significantly different between the modes. However, the coefficient of variation of VT was 10 ± 4.%, 20 ± 13 % and 15 ± 8 % during PSV, PAV80 and PAV50, respectively. Respiratory rate (RR) and minute ventilation (VE) were significantly lower during PAV80 as compared with both other modes, but the differences did not exceed 10 %. PAV80 and PSV had comparable effects on WOBI and P0.1, whereas WOBI and P0.1 increased during PAV50 compared with both other modes. Conclusion: Mean values of breathing pattern did not differ by a large amount between the investigated modes. However, the higher variability of VT during PAV indicates an increased ability of the patients to control VT in response to alterations in respiratory demand. A reduction in assist during PAV50 resulted in an increase in WOB and indices of patient effort.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050954
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    New modes of mechanical ventilation (1998)
    Springer
    Intensive care medicine 24 (1998), S. 1341-1342 
    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/s001340050774
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Severe accidental hypothermia: rewarming strategy using a veno-venous bypass system and a convective air warmer (1999)
    Springer
    Intensive care medicine 25 (1999), S. 520-523 
    Details
    ISSN: 1432-1238
    Keywords: Key words Accidental hypothermia ; Rewarming strategy ; Critical care ; Extracorporeal circulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To study a rewarming strategy for patients with severe accidental hypothermia using a simple veno-venous bypass in combination with a convective air warmer. Setting: Eighteen beds in a university hospital intensive care unit. Patients: Four adults admitted with a core temperature less than 30 °C. Hypothermia was caused by alcoholic intoxication in three patients and by drug overdose in one patient. Measurements and main results: All patients were rewarmed by a veno-venous bypass and in three cases a convective air warmer was also used. At a bypass flow rate of 100–300 ml/min the mean increase in core temperature was 1.15 °C/h (Range: 1.1–1.2 °C/h). One patient died 2 days after rewarming as a consequence of a reactivated pancreatitis. The other three patients survived without neurological sequelae. Conclusion: This rewarming technique seems safe and effective and allowed the controlled rewarming of our patients who suffered from severe accidental hypothermia
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050891
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Vorteile der assistierten Spontanatmung (1999)
    Springer
    Intensivmedizin und Notfallmedizin 36 (1999), S. S046 
    Details
    ISSN: 1435-1420
    Keywords: Key words Biphasic Positive Airway Pressure (BIPAP) – Airway Pressure Release Ventilation (APRV) – spontaneous breathing – acute respiratory distress syndrome – arterial oxygenation ; Schlüsselwörter Biphasic Positive Airway Pressure (BIPAP) – Airway Pressure Release Ventilation (APRV) – Spontanatmung – akutes Lungenversagen – Gasaustausch
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Spontanatmung unter Biphasic Positive Airway Pressure (BIPAP) oder Airway Pressure Release Ventilation (APRV) führt bei Patienten mit akutem Lungenversagen zu einer Reduktion des Blutflusses zu nicht ventilierten Shuntarealen, der Totraumventilation und einer Zunahme des PaO2. Bedingt durch die Spontanatmung nahm der venöse Rückstrom, das Herzzeitvolumen und die Sauerstofftransportkapazität zu, ohne daß der Sauerstoffverbrauch stieg. Bei Patienten, die unter APRV/BIPAP frühzeitig spontan atmeten, war der Gasaustausch signifikant besser als bei den Patienten, die zunächst drei Tage kontrolliert beatmet und anschließend mittels APRV/BIPAP entwöhnt wurden. Die Dauer der maschinellen Beatmung, der Intubation und des Intensivaufenthaltes waren bei Patienten, die frühzeitig unter APRV/BIPAP spontan atmeten, signifikant kürzer. APRV/BIPAP scheint als primäre Unterstützung einer insuffizienten Spontanatmung vorteilhaft zu sein.
    Notes: Summary Spontaneous breathing with Biphasic Positive Airway Pressure (BIPAP) or Airway Pressure Release Ventilation (APRV) caused a reduction in intrapulmonary shunting and dead space ventilation and improvement in arterial oxygenation in patients with acute respiratory distress syndrome. During spontaneous breathing with APRV/BIPAP venous return, cardiac output and oxygen delivery increased while oxygen consumption remained unchanged. In patients early spontaneous breathing with APRV/BIPAP was associated with a better arterial oxygenation than in patients receiving controlled mechanical ventilation for 3 days and were then weaned with APRV/BIPAP. Length of mechanical ventilation, intubation and ICU stay was shorter in patients breathing spontaneously early with APRV/BIPAP. Therefore, early spontaneous breathing with APRV/BIPAP may be of advantage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014609
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    Paper (German National Licenses)
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