Correlation of diaphragm thickening fraction and oesophageal pressure swing in non-invasive ventilation of healthy subjects.

Introduction: The diaphragm thickening fraction (DTF) may be a valuable tool for estimating respiratory effort in non-invasive ventilation. The primary aim of this physiological study is the investigation of the correlation of DTF with oesophageal pressure swings (ΔP). A secondary aim is to assess the discriminatory capacity of the index tests for different exercise loads.

Mask Continuous Positive Airway Pressure Increases Diaphragm Thickening Fraction in Healthy Subjects.

Introduction: The most widespread treatment for obstructive sleep apnoea and obesity hypoventilation syndrome is continuous positive airway pressure (CPAP). The addition of inspiratory support is a potential alternative. This is a physiological study to determine the effect of CPAP and inspiratory support pressure on respiratory effort measured by diaphragm thickening fraction (DTF) in healthy volunteers.

Hybrid pixel direct detector for electron energy loss spectroscopy.

We characterize a hybrid pixel direct detector and demonstrate its suitability for electron energy loss spectroscopy (EELS). The detector has a large dynamic range, narrow point spread function, detective quantum efficiency ≥ 0.8 even without single electron arrival discrimination, and it is resilient to radiation damage.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016.

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Complex relationship between free thyroxine and TSH in the regulation of thyroid function.

Objective: The present study re-evaluates the inverse log TSH-free thyroxine (fT(4)) relationship, which has generally been assumed to characterize the thyroid pituitary hypothalamic feedback regulation in thyroid function.

Design And Methods: The correlation between fT(4) and TSH was analyzed in two data sets from differing time periods involving 3223 and 6605 patients referred for thyroid testing, representing the whole range of thyroid functions from hypothyroidism to hyperthyroidism.

Results: We found that the data do not support a linear log TSH-fT(4) relationship; instead, the correlation's gradient varies with thyroid function.

Thromboembolic complications during weaning from right ventricular assist device support.

We report on two patients who experienced life-threatening thromboembolic complications during prolonged weaning from Levitronix CentriMag right ventricular assist device support. Right ventricular assist device flow in both patients was reduced below 2 L/min for a period of 72 or 36 h to closely monitor patients' hemodynamics and echocardiography because the extent of right ventricular recovery was difficult to assess. Thrombus formation occurred despite adjusting the heparin dosage to achieve partial prothrombin time values between 60 and 70 s.

Epidemiology of mechanical ventilation: analysis of the SAPS 3 database.

Objective: To evaluate current practice of mechanical ventilation in the ICU and the characteristics and outcomes of patients receiving it.

Design: Pre-planned sub-study of a multicenter, multinational cohort study (SAPS 3).

Patients: 13,322 patients admitted to 299 intensive care units (ICUs) from 35 countries.

The pediatric mechanical circulatory support program in Innsbruck, Austria, and the impact of such programs on lack of donor hearts in Europe.

Strategy and results of the Innsbruck Mechanical Circulatory Support Program are presented, and the impact of such programs on pediatric heart transplantation (HTX) in Europe is discussed. Venoarterial extracorporeal membrane oxygenation (vaECMO) and ventricular assist devices (VADs) were used in 21 pediatric patients (median age 3.3 years, 2 days to 17 years) for acute heart failure (AHF) following a bridge or bridge-to-bridge strategy.

Caspofungin-resistant Aspergillus flavus after heart transplantation and mechanical circulatory support: a case report.

Invasive aspergillosis (IA) is a severe complication in the post-transplant period in recipients of solid organs. Therefore, early diagnosis and specific therapy of fungal infections in these patients are indispensable. We report the case of a 49-year-old patient, who suffered from IA after cardiac transplantation, which was complicated by post-transplant right heart failure requiring mechanical circulatory support using veno-arterial extracorporeal membrane oxygenation and a right ventricular assist device.

Interventional and medical treatment of acute heart failure due to inflammation: four cases.

Four patients (aged 15-41 years, mean age 26.7 years) with fulminant myocarditis undergoing mechanical circulatory support are reported. All patients suffered from acute low-output syndrome refractory to inotropic support.

Outcome evaluation of the bridge-to-bridge concept in patients with cardiogenic shock.

Background: Patients with cardiogenic shock can be stabilized by percutaneous implantation of extracorporeal membrane oxygenation (ECMO). If weaning from ECMO is impossible, the implantation of a ventricular assist device (VAD) is required. Patients either go for recovery of myocardial function (bridge to recovery) or for heart transplantation (bridge to transplant).

Successful administration of levosimendan in a patient with low-gradient low-output aortic stenosis.

Aortic valve replacement in patients suffering from low-gradient aortic stenosis and congestive heart failure is associated with high operative mortality, and the perioperative use of inotropes is common. Levosimendan is a calcium sensitizer with positive inotropic and vasodilatory effects and has been developed for treatment of decompensated heart failure. Although its use in patients with low-gradient aortic stenosis is not established, we hypothesized that it might have beneficial effects on outcome after aortic valve replacement.

Early detection and successful therapy of fulminant chlamydia pneumoniae myocarditis.

We report a case involving a young female patient with Chlamydia pneumoniae myocarditis who required assist device therapy for acute heart failure. Early diagnosis was provided by endomyocardial biopsy, and tailored antibiotic therapy facilitated quick recovery of myocardial function. This is the first case to report detecting C pneumoniae as the pathogen responsible for fulminant myocarditis while the patient was still alive and to report long-term follow-up data.

Pressure support ventilation with the ProSeal laryngeal mask airway. A comparison of sevoflurane, isoflurane and propofol.

Background And Objective: There are no data about the influence of anaesthetics on cardiovascular variables during pressure support ventilation of the lungs through the laryngeal mask airway. We compared propofol, sevoflurane and isoflurane for maintenance of anaesthesia with the ProSeal laryngeal mask airway during pressure support ventilation.

Methods: Sixty healthy adults undergoing peripheral musculo-skeletal surgery were randomized for maintenance with sevoflurane end-tidal 2%, isoflurane end-tidal 1.

Cardiac transplantation complicated by acute thrombotic occlusion of the right coronary artery.

We report the case of a 63-year-old male patient undergoing cardiac transplantation due to fourth time aortic valve endocarditis. The postoperative course was complicated by thrombotic occlusion of the right coronary artery (RCA) causing acute right ventricular myocardial infarction, which required extracorporeal membrane oxygenation. The RCA could be reopened by catheter-based intervention and the patient stabilized.

Incidence of coronary heart disease and cardiac events in patients undergoing kidney and pancreatic transplantation.

One major cause of graft loss after kidney transplantation or simultaneous kidney and pancreas transplantation is death of the recipient due to cardiac events. Records of 261 patients who underwent sole kidney (group A) or combined kidney-pancreas transplantation (group B) were retrospectively analyzed. Patients were divided into groups with basic cardiac evaluation (chest X-ray, electrocardiogram) and patients with additional diagnostics [echocardiography, exercise stress test, myocardial perfusion test, and coronary angiography (CAG)].

Proportional assist ventilation reduces the work of breathing during exercise at moderate altitude.

Reducing the work of breathing (WOB) during exercise and thus the oxygen required solely for ventilation may be an option to increase the oxygen available for nonventilatory physiological tasks at altitude. This study evaluated whether pressure support ventilation (PSV) and proportional assist ventilation (PAV) may partially reduce WOB during exercise at altitude. Seven volunteers breathing with either PSV or PAV or without support (control) were examined for WOB, inspiratory pressure time product (iPTP), and (O(2)) before and during pedaling at 160 W for 4 min on an ergometer at an altitude of 2860 m, where barometric pressure and oxygen partial pressure are approximately 30% less than at sea level.

Positive pressure versus pressure support ventilation at different levels of PEEP using the ProSeal laryngeal mask airway.

We compared positive pressure ventilation with pressure support ventilation at different levels of positive end expiratory pressure (PEEP) using the ProSeal laryngeal mask airway (PLMA). Forty-two anaesthetized adults (ASA 1-2, aged 19 to 63 years) underwent positive pressure ventilation and then pressure support ventilation each with PEEP set at 0, 5 and 10 cmH2O in random order. Pressure support ventilation was with the inspired tidal volume (VTInsp) set at 7 ml/kg and the respiratory rate adjusted to maintain the end-tidal CO2 (ETCO2) at 40 mmHg.

Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support.

Objective: Mechanical circulatory support can maintain vital organ perfusion in patients with cardiac failure unresponsive to standard pharmacologic treatment. The purpose of the current study was to report complication and survival rates in patients supported with emergency percutaneous venoarterial cardiopulmonary bypass because of prolonged cardiogenic shock or cardiopulmonary arrest.

Design: Retrospective clinical study.

Augmented spontaneous breathing and pulmonary gas exchange during pneumoperitoneum.

Background And Objective: Ventilation of the lungs with positive end-expiratory pressure during pneumoperitoneum has been shown to improve the arterial partial pressure of oxygen. The implications of spontaneous breathing on pulmonary gas exchange remain unknown in this setting. We therefore sought to examine the influence of pressure-support ventilation with spontaneous breathing on gas exchange during simulated laparoscopy.

Isoflurane and sevoflurane anesthesia in pigs with a preexistent gas exchange defect.

Background: Decreased arterial partial pressure of oxygen (PaO2) during volatile anesthesia is well-known. Halothane has been examined with the multiple inert gas elimination technique and has been shown to alter the distribution of pulmonary blood flow and thus PaO2. The effects of isoflurane and sevoflurane on pulmonary gas exchange remain unknown.

Liver transplantation without venovenous bypass: morbidity and mortality in patients with greater than 50% reduction in cardiac output after vena cava clamping.

Objective: To investigate whether a decrease in cardiac output of >or=50% after vena cava clamping is associated with an increase in perioperative morbidity or mortality in patients undergoing orthotopic liver transplantation without venovenous bypass.

Design: Retrospective, clinical study.

Participants: Patients undergoing elective orthotopic liver transplantation without venovenous bypass (n = 172).

Sildenafil modulates hemodynamics and pulmonary gas exchange.

The effects of sildenafil (Viagra) on hemodynamics and pulmonary gas exchange remain uncertain. The aim of this study was to investigate what effect sildenafil had on gas exchange. A total of 24 anesthetized pigs were randomly assigned into four groups of six animals each: Group Low received 25 mg of sildenafil, which is equivalent to half the recommended dose for humans; group Normal received 50 mg; group High received 100 mg; and one group served as control.