Outcome of acute respiratory distress syndrome in university and non-university hospitals in Germany.

Background: This study investigates differences in treatment and outcome of ventilated patients with acute respiratory distress syndrome (ARDS) between university and non-university hospitals in Germany.

Methods: This subanalysis of a prospective, observational cohort study was performed to identify independent risk factors for mortality by examining: baseline factors, ventilator settings (e.g.

Aerosol delivery by an ultrasonic nebulizer during different mechanical ventilation settings in a lung model--a pilot study.

Unlabelled: Aerosol delivery of Iloprost is a promising therapeutic approach. The aim of this study was to determine the output of an ultrasonic nebulizer in different ventilation set-ups at the tip of different endotracheal tubes.

Method: In set-up A, an ultrasonic nebulizer was connected directly to the endotracheal tube.

Thromboelastometry-guided administration of fibrinogen concentrate for the treatment of excessive intraoperative bleeding in thoracoabdominal aortic aneurysm surgery.

Objective: Thoracoabdominal aortic aneurysm operations are associated with extensive blood loss and high requirements for allogeneic blood product transfusion. We assessed the efficacy of intraoperative post-cardiopulmonary bypass administration of fibrinogen concentrate in elective thoracoabdominal aortic aneurysm surgery.

Methods: In a retrospective group (group A, n = 12) of patients undergoing elective thoracoabdominal aortic aneurysm surgery, clinically relevant diffuse bleeding after weaning from cardiopulmonary bypass was treated with allogeneic blood products (platelet concentrates, followed by fresh frozen plasma) according to a predetermined algorithm.

Skin impedance correlates to sedation grade, plasma propofol concentrations and bispectral index during a target-controlled infusion of propofol.

Background And Objective: Sympathetic activity, measured as changes in electrical skin impedance, may be used to assess the adequacy of general anaesthesia. The aim of this prospective study was to evaluate electrical skin impedance in comparison with bispectral index values and the Observer's Assessment of Alertness and Sedation (OAAS) scale during propofol infusion.

Methods: Electrical skin impedance was measured with an electrosympathicograph.

The effects of fibrinogen levels on thromboelastometric variables in the presence of thrombocytopenia.

Background: The binding of fibrinogen and fibrin to platelets is important in normal hemostasis. The extent of platelet-fibrin interaction can be measured as the viscoelastic strength of clot by rotational thromboelastometry (ROTEM). In this study, we investigated the effect of fibrinogen concentration and its relative contribution to overall clot strength using ROTEM.

Percutaneous interventions for treating ischemic complications of aortic dissection.

The aim of this study was to evaluate the role of percutaneous interventions in treating ischemia complicating aortic dissection. Forty-five patients with ischemia complicating aortic dissection were treated by balloon fenestration, true lumen stenting, angioplasty, or thrombolysis. Clinical and laboratory examinations were performed before and after intervention, and at the end of follow-up (median 37 months).

Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial.

The objective of the study was to evaluate the effectiveness of chlorhexidine-impregnated sponges for reducing catheter-related infections of central venous catheters inserted for cancer chemotherapy. The method used was a randomized, prospective, open, controlled clinical study (three-step group sequential analysis protocol). The patients were from two high dependency units at a university hospital undergoing chemotherapy for haematological or oncological malignancies requiring central venous catheters (CVCs) expected to remain in place for at least 5 days.

Complex myograph allows the examination of complex muscle contractions for the assessment of muscle force, shortening, velocity, and work in vivo.

Background: The devices used for in vivo examination of muscle contractions assess only pure force contractions and the so-called isokinetic contractions. In isokinetic experiments, the extremity and its muscle are artificially moved with constant velocity by the measuring device, while a tetanic contraction is induced in the muscle, either by electrical stimulation or by maximal voluntary activation. With these systems, experiments cannot be performed at pre-defined, constant muscle length, single contractions cannot be evaluated individually and the separate examination of the isometric and the isotonic components of single contractions is not possible.

Comparison of inhaled iloprost and nitric oxide in patients with pulmonary hypertension during weaning from cardiopulmonary bypass in cardiac surgery: a prospective randomized trial.

Objective: The objective of this study was to compare the efficacy of inhaled iloprost and nitric oxide (iNO) in reducing pulmonary hypertension (PHT) during cardiac surgery immediately after weaning from cardiopulmonary bypass (CPB).

Design: A prospective randomized study.

Setting: A single-center university hospital.

Effects of pharmacological intervention on coagulopathy and organ function in xenoperfused kidneys.

Background: Following pig to primate kidney transplantation, xenogenic activation of the coagulation (XAC) system of the recipient eventually leading to organ dysfunction and disseminated intravascular coagulation (DIC) can be observed.

Methods: Using an ex-vivo perfusion circuit based on low-dose heparin-mediated anticoagulation and exogenous complement inhibition by C1- Inhibitor (C1-Inh), we have analysed XAC following contact of human blood with porcine endothelium. Porcine kidneys (n = 23) were recovered following in situ cold perfusion with histidine-tryptophan-ketoglutarate (HTK) solution and were connected to a perfusion circuit utilizing freshly drawn pooled human AB blood.

Renal transplantation normalized hydrogen peroxide production of neutrophils within the first day.

Background: Hemodialysis patients are in a state of oxidant stress. In renal transplantation reactive oxygen species (ROS) are considered to be important factors of ischemia-reperfusion injury. Neutrophils produce ROS as part of the host defense against invading bacteria.

Assessment of precision and reproducibility of a new myograph.

Background: The physiological characteristics of muscle activity and the assessment of muscle strength represent important diagnostic information. There are many devices that measure muscle force in humans, but some require voluntary contractions, which are difficult to assess in weak or unconscious patients who are unable to complete a full range of voluntary force assessment tasks. Other devices, which obtain standard muscle contractions by electric stimulations, do not have the technology required to induce and measure reproducible valid contractions at the optimum muscle length.

Prospective investigation into the influence of various stressors on skin impedance.

Background: The control mechanisms during general anesthesia include circulation parameters and vegetative reactions. A possible way to quantify vegetative reactions is to measure the impedance of the skin. An activation of the eccrine sweat glands via sympathetic sudomotor fibers induces a secretion of sweat, which generates a drop in skin impedance.

In vivo myograph measurement of muscle contraction at optimal length.

Background: Current devices for measuring muscle contraction in vivo have limited accuracy in establishing and re-establishing the optimum muscle length. They are variable in the reproducibility to determine the muscle contraction at this length, and often do not maintain precise conditions during the examination. Consequently, for clinical testing only semi-quantitative methods have been used.

Continuous monitoring of central venous oxygen saturation in neonates and small infants: in vitro evaluation of two different oximetry catheters.

Background: Accurate assessment and monitoring of the cardiocirculatory function are essential during major pediatric and pediatric cardiac surgery. Monitoring of the central venous oxygen saturation (ScvO(2)) may be a better indicator of tissue oxygenation and derangement of cellular oxygen utilization than the more commonly used vital parameters. Therefore, we compared oxygen saturation measurements with thin fiberoptic oximetry catheters and standard blood gas oximetry in an in vitro setting.

Effectiveness and safety of internal rectilinear biphasic versus monophasic defibrillation in patients undergoing cardiac surgery.

Background: Recently it has been shown that biphasic external shocks are more effective in the treatment of ventricular fibrillation (VF) compared with monophasic external shocks in terms of number of defibrillation attempts and maximal energy used for termination of VF. Biphasic defibrillators apply different biphasic impulse forms, depending on technology. To the authors' knowledge, there are no existing data concerning the effects of rectilinear biphasic internal shocks in patients undergoing cardiac surgery.

Platelet P-selectin and GPIIb/IIIa expression after liver transplantation and resection.

Platelet dysfunction contributes to haemostatic defects, possibly leading to bleeding complications. We hypothesised that liver transplantation and liver resection, together with portal clamping time, might be a potential stimulus for platelet activation. Therefore, we determined the expression of platelet GPIIb/IIIa and P-selectin, representing important platelet activation markers, and the thrombopoietin (TPO) serum level after transplantation and resection.

beta(2)-Agonist delivery via a resuscitator bag (Ambu MediBag): a comparison with a metered-dose inhaler using the Volumatic-Spacer.

Although the administration of beta(2)-agonists by inhalation is recommended in the current guidelines for treatment of patients with acute bronchospasm, the large volume spacer that is necessary often is not available on board an ambulance due to space storage problems. Accordingly, an adapter enabling the application of therapeutic aerosols from a metered-dose inhaler (MDI) via a resuscitator bag (Ambu MediBag) was developed. The aim of this double-blinded, randomised study was to test the clinical efficiency of the Ambu MediBag (volume: approximately 1500 ml) in comparison with the commonly used Volumatic-Spacer (volume: 750 ml).

Lack of influence of the COX inhibitors metamizol and diclofenac on platelet GPIIb/IIIa and P-selectin expression in vitro.

BACKGROUND: The effect of non-steroidal anti-inflammatory drugs (NSAIDs) for reduced platelet aggregation and thromboxane A2 synthesis has been well documented. However, the influence on platelet function is not fully explained. Aim of this study was to examine the influence of the COX-1 inhibiting NSAIDs, diclofenac and metamizol on platelet activation and leukocyte-platelet complexes, in vitro.

Gender differences in coping with tension-type headaches.

Objective: To study gender differences of coping with illness strategies in tension-type headaches.

Method: We enrolled 89 subjects (50 women, 39 men) suffering from episodic (n = 37) and chronic (n = 52) tension-type headaches (TTH). Patients were required to answer a Freiburg Questionnaire of Coping with Illness (FQCI), a Von Zerssen Depression Scale (D-S), quality-of-life questionnaires, and a headache home diary (over 4 weeks).

Effect of celecoxib and dexamethasone on postoperative pain after lumbar disc surgery.

Objective: This study was designed to assess the efficacy of perioperative administration of celecoxib (Celebrex; Pharmacia GmbH, Erlangen, Germany) in reducing pain and opioid requirements after single-level lumbar microdiscectomy.

Methods: We studied 34 patients (mean age, 44.26 yr; standard deviation [SD], 13.