Alveolar recruitment during prone position: time matters.

Alveolar recruitment is one of the beneficial effects of prone positioning in patients with ARDS (acute respiratory distress syndrome). However, responses vary among patients and, therefore, we hypothesized that alveolar recruitment is an individual time-dependent process and its measurement might be helpful to 'dose' prone positioning individually. In 13 patients diagnosed with ARDS, EELV (end-expiratory lung volume) was measured in the supine position, immediately after turning to the prone position, at 1, 2, 4 and 8 h in the prone position and after returning to the supine position.

Volume measurement of cerebral blood flow: assessment of cerebral circulatory arrest.

Background: Cerebral blood flow (CBF) volume can be measured at bedside by color duplex flowmetry of the extracranial cerebral arteries. In neurointensive care patients, we prospectively tested the hypothesis that a CBF volume <100 ml/min indicates imminent cerebral circulatory arrest.

Methods: CBF volume was determined as sum of flow volumes in the internal carotid and vertebral arteries of both sides.

Management of liver transplantation in a patient with a history of heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) is an adverse immune-mediated drug reaction in which antibodies are generated usually towards complexes of the soluble platelet protein platelet-factor-4 (PF4) and heparin. The resulting immune complexes activate platelets intravascularly, which increases the generation of thrombin. Therefore, HIT is strongly associated with thrombosis and heparin is thought to be contraindicated.

Influence of underlying disease on the outcome of critically ill patients with acute renal failure.

Background And Objective: The development of acute renal failure (ARF) in critically ill patients is associated with an increase in hospital mortality. Recently, it was shown that starting renal replacement therapy early and using high-filtrate flow rates can improve the outcome, but this could not be confirmed in later investigations. Studying selected patient subgroups could provide a useful basis for patient selection in future trials evaluating the outcome of renal replacement therapies.

[Noninvasive determination of cardiac output in ventilated patients . Clinical evaluation of a simplified quick method].

Objective: This study was performed to evaluate a new simplified rebreathing method to determine cardiac output (CO) in mechanically ventilated patients.

Methods: Using a rebreathing system (AMIS 2001, Innovision, Dänemark), effective pulmonary blood flow (PBF) and oxygen consumption (V(radical)O2) were determined non-invasively in 40 patients. After estimation of arterial (CaO2) and capillary oxygen (CcO2) content from the results of an arterial blood gas analysis, intrapulmonary shunt was calculated as Q(s)/Q(t) = [CcO2CaO2] * PBF/V(radical)O(2).

Non-invasive determination of effective pulmonary blood flow: evaluation of a simplified rebreathing method.

Primary Objective: To evaluate a new technical approach to measuring effective pulmonary blood flow (PBF) in mechanically ventilated patients.

Research Design: Prospective clinical study; evaluation of accuracy and reproducibility.

Methods: Effective pulmonary blood flow was determined non-invasively in 32 mechanically ventilated patients by using a new rebreathing system (PBF(rb)).

Non-invasive measurement of pulmonary blood flow during prone positioning in patients with early acute respiratory distress syndrome.

In the daily clinical routine at the bedside, information on effective pulmonary blood flow (PBF) is limited and requires invasive monitoring, including a pulmonary artery catheter, to determine both cardiac output and intrapulmonary shunt. Therefore we evaluated a non-invasive method for the measurement of PBF in a clinical setting, including 12 patients with acute respiratory failure (acute respiratory distress syndrome) undergoing prone positioning. PBF was determined before (baseline), during and after prone positioning, by using a foreign gas rebreathing method with a new photoacoustic gas analyser.

Patient data management systems in critical care.

Electronic patient data management systems (PDMS) were clinically used for the first time in the 1970s. Their purpose was to automatically document vital parameters sampled by monitors and to replace handwritten medical files. Because of the continuous development of computer technology, however, demands on PDMS have increased immensely.

ICP measurement control: laboratory test of 7 types of intracranial pressure transducers.

Intracranial pressure (ICP) monitoring has become an important parameter in the assessment of comatose patients, with raised intracranial pressure. The transducers in use have to fulfill the criteria of measurement accuracy, practicability and cost-effectiveness. However, these requirements are not always met in clinical practice.

Implementation of an interactive computer-assisted infection monitoring program at the bedside.

A new computer-assisted infection monitoring (CAI) software program has been developed for use in an intensive-care unit (ICU). By means of an interactive dialogue with physicians at the bedside, infection diagnoses and therapeutic decisions were recorded prospectively during a 3-month test period. By linking epidemiological data with information about therapeutic decisions, CAI could assess the quality of the therapeutic decisions.

New aspects of pulmonary mechanics: "slowly" distensible compartments of the respiratory system, identified by a PEEP step maneuver.

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.

[First aid and prognosis following drowning accidents. Results of a retrospective study of 115 cases].

Objective And Study Design: In 115 cases of submersion the initial findings of the rescue team, the patients status in the emergency room and the course of clinical treatment were analyzed retrospectively.

Results: Submersion accidents happened preferably in February, March and in the summertime from May to August. Most of the accidents took place in public waters or public baths (85.

Pulmonary venodilation by isoflurane improves gas exchange during Escherichia coli bacteremia.

Objective: To determine how isoflurance affects the longitudinal distribution of pulmonary vascular resistance and pulmonary gas exchange during Escherichia coli bacteremia.

Design: Prospective, controlled study with open-label assignment of animals to two groups.

Setting: Laboratory.

[Longitudinal distribution of pulmonary vascular resistance in patients with acute respiratory insufficiency].

Effective pulmonary capillary pressure (Pc) is a major factor determining transvascular fluid filtration in the lung. It may easily be estimated from the pressure decay after rapid pulmonary artery occlusion. If Pc is known, the longitudinal distribution of pulmonary vascular resistance (PVR) can be evaluated.

A simple method to estimate functional residual capacity in mechanically ventilated patients.

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.

[Capnometry in pediatric anesthesia. The effect of the measurement site and respiratory rate].

Objective: To evaluate the influences of site of measurement, respiratory rate, and tidal volume on end-tidal PCO2 measurement in children ventilated with a non-rebreathing system.

Setting: Paediatric surgical patients of a university hospital.

Patients: Thirty-one children scheduled for major abdominal or urogenital surgery; weight varying between 2.

[Amrinone for cardiovascular therapy in hypodynamic septic patients?].

Pulmonary hypertension, systemic vasodilation and the supply dependency of oxygen uptake are the major problems associated with sepsis. Thus, the goal of haemodynamic therapy in septic patients is an increase in cardiac output large enough to permit adequate tissue oxygenation. The purpose of this study was to establish whether the additional use of the phosphodiesterase inhibitor amrinone is useful in hypodynamic septic patients with inadequate tissue perfusion.

[Risk indicators in coronary surgery].

We examined the perioperative course of 1013 patients who had undergone coronary surgery between 1984 and 1987, to identify preoperative examination findings which are suitable as risk indicators in coronary surgery. The features we paid attention to were: anamnestic data, parameters of coronary disease, haemodynamic parameters and accompanying illnesses. We considered a perioperative course as complicated when systolic blood pressure dropped to 80 mmHg or less for longer than 15 min, when reconnection to the heart-lung-machine was necessary, when an intra-aortal balloon counterpulsation was required, when the patient had to have mechanical ventilation for longer than 24 h, when resuscitation took place, or when the patient died in the hospital.

Pulmonary artery occlusion-left atrial pressure gradient: an important factor in determining pulmonary venous vascular resistance in acute pulmonary failure.

Objective: To determine whether pulmonary artery occlusion pressure (PAOP) accurately reflects left atrial pressure (LAP) in acute pulmonary failure.

Design: Sham-controlled laboratory investigation on Goettingen minipigs.

Interventions: Induction of acute respiratory failure by a 4-hr infusion of live Escherichia coli bacteria in 11 animals; two animals served as the control group.