Interstitial fluid shifts in simulated long-haul flights monitored by a miniature ultrasound device.

Background: Long-haul flights (LHF) are known to be connected with an increased risk of deep vein thrombosis. There is still some lack of clarity about the impact of hypoxia and lower levels of air pressure and humidity on passengers during flight. This cross-over study researched interstitial fluid shifts traced by measurements of tissue thickness (TT) under controlled simulated conditions of a LHF.

Functional residual capacity-guided alveolar recruitment strategy after endotracheal suctioning in cardiac surgery patients.

Objective: To determine whether the results of functional residual capacity measurements after endotracheal suctioning could guide the decision to perform an alveolar recruitment maneuver and thus improve lung function.

Design: Prospective, randomized, controlled interventional study.

Setting: Intensive care unit of a university hospital.

Leukocyte depletion during cardiopulmonary bypass in routine adult cardiac surgery.

Objectives: Cardiopulmonary bypass (CPB) elicits an inflammatory response which is potentially harmful and that is partly caused by activation of leukocytes. Despite promise from earlier studies, however, the value of intraoperative leukocyte-depletion (LD) remains equivocal. We studied the effect of LD during routine cardiac surgery.

Relationship between functional residual capacity, respiratory compliance, and oxygenation in patients ventilated after cardiac surgery.

Background: Measurement of functional residual capacity (FRC) is now possible at bedside, during mechanical ventilation.

Objectives: To determine the relationship of measured absolute and relative predicted FRC values to oxygenation and respiratory-system compliance, and to identify variables that influence FRC in ventilated patients after cardiac surgery.

Methods: We retrospectively analyzed data from 99 patients ventilated after cardiac surgery.

Detection of 140 clinically relevant antibiotic-resistance genes in the plasmid metagenome of wastewater treatment plant bacteria showing reduced susceptibility to selected antibiotics.

To detect plasmid-borne antibiotic-resistance genes in wastewater treatment plant (WWTP) bacteria, 192 resistance-gene-specific PCR primer pairs were designed and synthesized. Subsequent PCR analyses on total plasmid DNA preparations obtained from bacteria of activated sludge or the WWTP's final effluents led to the identification of, respectively, 140 and 123 different resistance-gene-specific amplicons. The genes detected included aminoglycoside, beta-lactam, chloramphenicol, fluoroquinolone, macrolide, rifampicin, tetracycline, trimethoprim and sulfonamide resistance genes as well as multidrug efflux and small multidrug resistance genes.

Changes in functional residual capacity during weaning from mechanical ventilation: a pilot study.

Background: Reduction of high positive end-expiratory pressure levels and pressure support ventilation (PSV) are frequently used before tracheal extubation in critically ill patients, but the impact of PSV on functional residual capacity (FRC) is unknown. In this study, we sought to detect the changes of FRC and pulmonary function during a weaning protocol in patients ventilated after cardiac surgery.

Methods: The LUFU system (Dräger Medical, Lübeck, Germany) estimates FRC by oxygen washout, a variant of multiple breath nitrogen washout, using a sidestream O(2) analyzer.

Functional residual capacity changes after different endotracheal suctioning methods.

Background: Our primary objective was to investigate the effects of three different endotracheal suctioning procedures on functional residual capacity (FRC).

Methods: Using a crossover design, postoperative cardiac surgery patients (n = 20) received three different suctioning methods in randomized order: closed suctioning during pressure-controlled ventilation, closed suctioning during volume-controlled ventilation, and open suctioning. FRC was measured before and 20 min after the intervention.

Insight into the plasmid metagenome of wastewater treatment plant bacteria showing reduced susceptibility to antimicrobial drugs analysed by the 454-pyrosequencing technology.

Wastewater treatment plants (WWTPs) are a reservoir for bacteria harbouring antibiotic resistance plasmids. To get a comprehensive overview on the plasmid metagenome of WWTP bacteria showing reduced susceptibility to certain antimicrobial drugs an ultrafast sequencing approach applying the 454-technology was carried out. One run on the GS 20 System yielded 346,427 reads with an average read length of 104 bases resulting in a total of 36,071,493 bases sequence data.

The impact of different step changes of inspiratory fraction of oxygen on functional residual capacity measurements using the oxygen washout technique in ventilated patients.

Background: Functional residual capacity (FRC) measurements may help to guide respiratory therapy. Using the oxygen washout technique, FRC can be assessed at bedside during spontaneous breathing. High repeatability, crucial for monitoring, has not been shown in ventilated patients.

A single prophylactic dose of pentoxifylline reduces high dependency unit time in cardiac surgery - a prospective randomized and controlled study.

Background: The pathogenesis of the post cardiopulmonary bypass (CPB) organ dysfunction syndrome is complex, with inflammation being an important component. The purpose of this prospective, randomized and controlled study was to evaluate the effect of a single dose of pentoxifylline (PTX) prior to CPB on high dependency unit time.

Materials And Methods: We studied 39 patients undergoing aorto-coronary bypass surgery with CPB.

The accuracy of the oxygen washout technique for functional residual capacity assessment during spontaneous breathing.

Background: Measurement of functional residual capacity (FRC) is of considerable interest for monitoring patients with lung injury. The lack of instruments has impeded routine bedside FRC measurement. Recently, a simple automated method for FRC assessment by O2 washout has been introduced.

Intercompartmental fluid volume shifts during cardiopulmonary bypass measured by A-mode ultrasonography.

To investigate the time course of fluid extravasation during cardiopulmonary bypass (CPB), we measured the peripheral tissue thickness (TT) by A-mode ultrasound in 34 patients undergoing elective cardiac surgery. TT of the forehead was determined by a handheld A-mode ultrasound device and 10 MHz Transducer at nine defined intervals, from the night before surgery until the first postoperative day. Mean calculated loss of 1700 +/- 40 mL (SEM) water during the fasting period resulted in a significant reduction of TT by 0.

Hypergravity and dehydration-induced shifts of interstitial fluid in the skin monitored by ultrasound.

Introduction: Spaceflight is associated with a shift of interstitial fluid toward the skin of the head and a fluid loss that can decrease superficial tissue thickness (TT). To collect the physiological data needed to develop techniques for monitoring the hydration status of astronauts during spaceflight, we investigated the changes in TT induced by a 12-h nil-by-mouth period and a 30-min period of +2 Gz hypergravity measured at forehead and tibia.

Methods: There were 16 male volunteers who were twice subjected to 30 min of +2 Gz acceleration in a human centrifuge, once following an oral fluid load of 250 ml x h(-1) (procedure A), and once following a nil-by-mouth period of 12 h (procedure B).

Na /H+ exchange inhibitor cariporide: effects on respiratory dysfunction after cardiopulmonary bypass.

The purpose of the present study was to evaluate the potential of the Na+/H+ exchange inhibitor cariporide to protect the lung from injury after cardiopulmonary bypass (CPB). In a randomized placebo-controlled study, 16 pigs were subjected to CPB for 75 min. Administration of vehicle or cariporide (bolus 180 mg, 40 mg/hour) began 30 min pre-CPB and was continued throughout the protocol.

Effects of tilting and volume loading on plasma levels and urinary excretion of relaxin, NT-pro-ANP, and NT-pro-BNP in male volunteers.

The polypeptide relaxin (RLX) has been suggested to play a role in cardiorenal integration and to be related to the natriuretic peptide system. We hence examined the effects of variations in thoracic blood volume and intravenous volume loading on plasma and urinary RLX levels and associated changes in natriuretic peptide levels in healthy men. Two groups of eight subjects were randomly tilted into a 15 degrees feet-down or a 15 degrees head-down position.

A rise of MMP-2 and MMP-9 in bronchoalveolar lavage fluid is associated with acute lung injury after cardiopulmonary bypass in a swine model.

Postoperative acute lung injury (ALI) contributes to the morbidity and mortality following cardiopulmonary bypass (CPB). To determine whether the presence of matrix metalloproteinases (MMPs) is associated with ALI after CPB, MMP-2 and MMP-9 activities in bronchoalveolar lavage fluid (BALF) were compared with parameters indicating impaired gas exchange. In a prospective study, 17 minipigs were subjected to CPB for 60 min.

Prophylactic gamma radiation of unaffected vein grafts failed to prevent vein graft disease in a chronic hypercholesterolemic porcine model.

Objective: The value of prophylactic brachytherapy on vein graft disease is unknown.

Methods And Results: Vein bypass grafts in 23 hypercholesterolemic pigs after ex vivo gamma irradiation of the vein grafts (10, 20, and 40Gy) and 16 control veins were analyzed regarding: (1) expression of platelet-derived growth factor (PDGF-AA and -BB, ELISA); (2) smooth muscle cell (SMC) proliferation/cell death (double-immunohistochemistry Mib-1/TUNEL/SMC alpha-actin); and (3) vessel wall dimensions. Planimetric data on vessel wall dimensions revealed no positive effect of gamma radiation on neointima formation and inner lumen diameter.

Pulmonary matrix metalloproteinase excess in hospital-acquired pneumonia.

In hospital-acquired pneumonia, extracellular matrix destruction is common and may be caused by excessive activity of matrix metalloproteinases (MMPs). Thirty patients with hospital-acquired pneumonia and 16 control subjects were studied. We evaluated the concentrations of MMP-8, MMP-9, and tissue inhibitor of metalloproteinase-1 in mini-bronchoalveolar lavage fluid (mini-BALF) and blood using zymography and specific immunoassays.

Automated evaluation of functional residual capacity by oxygen washout.

Objective: Measurement of functional residual capacity (FRC) is of considerable interest for monitoring ventilated patients in ICUs. However, the lack of instruments that can be used in the clinical setting has so far impeded the routine application of this measurement. It was the aim of our study to evaluate the accuracy and the reproducibility of a simplified oxygen washout technique (FRC[O2]).

Assessment of fluid balance by measurement of skin tissue thickness during clinical anaesthesia.

Study Objective: To determine if measuring skin tissue thickness by a recently developed 10 MHz ultrasound scan may be used as a valuable parameter to guide fluid therapy and detect fluid shifts to the extravascular space during surgical procedures in addition to central venous pressure (CVP).

Study Design: Prospective, clinical and observational study.

Setting: An operation theatre of the Ear Nose Throat (ENT) department of an university hospital.