Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    ISSN: 1432-1238
    Keywords: Weaning CPAP ; BiPAP ; Extravascular lung water ; Cardiac surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the effects of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) on extravascular lung water during weaning from mechanical ventilation in patients following coronary artery bypass grafting. Design Prospective, randomized clinical study. Setting Intensive care unit at a university hospital. Patients Seventy-five patients following coronary artery bypass grafting. Interventions After extubation of the trachea, patients were treated for 30 min with CPAP via face mask (n=25), with nasal BiPAP (n=25), or with oxygen administration via nasal cannula combined with routine chest physiotherapy (RCP) for 10 min (n=25). Measurements and results Extravascular lung water (EVLW), pulmonary blood volume index (PBVI) and cardiac index (CI) were obtained during mechanical ventilation (T1), T-piece breathing (T2), interventions (T3), spontaneous breathing 60 min (T4) and 90 min (T5) after extubation of the trachea using a combined dye-thermal dilution method. Changing from mechanical ventilation to T-piece breathing did not show any significant differences in EVLW between the three groups, but a significant increase in PBVI from 155±5 ml/m2 to 170±4 ml/m2 could be observed in all groups (p〈0.05). After extubation of the trachea and treatment with BiPAP, PBVI decreased significantly to 134±6 ml/m2 (p〈0.05). After treatment with CPAP or BiPAP, EVLW did not change significantly in these groups (5.5±0.3 ml/kg vs 5.0±0.4 ml/kg and 5.1±0.4 ml/kg vs 5.7±0.4 ml/kg). In the RCP-treated group, however, EVLW increased significantly from 5.8±0.3 ml/kg to 7.1±0.4 ml/kg (p〈0.05). Sixty and 90 min after extubation, EVLW stayed at a significantly higher level in the RCP-treated group (7.5±0.5 ml/kg and 7.4±0.5 ml/kg) than in the CPAP-(5.6±0.3 ml/kg and 5.9±0.4 ml/kg). No significant differences in CI could be observed within the three groups during the time period from mechanical ventilation to 90 min after extubation of the trachea. Conclusions Mask CPAP and nasal BiPAP after extubation of the trachea prevent the increase in extravascular lung water during weaning from mechanical ventilation. This effect is seen for at least 1 h after the discontinuation of CPAP or BiPAP treatment. Fuether studies have to evaluate the clinical relavance of this phenomenon.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 2
    ISSN: 1432-1238
    Keywords: Key words Brain resuscitation ; Cardiac arrest ; Cerebral ischemia ; Microcirculation ; Thrombolytic therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Successful resuscitation of the brain requires complete microcirculatory reperfusion, which, however, may be impaired by activation of blood coagulation after cardiac arrest. The study addresses the question of whether postischemic thrombolysis is effective in reducing cerebral no-reflow phenomenon. Design: 14 adult normothermic cats were submitted to 15-min cardiac arrest, followed by cardiopulmonary resuscitation (CPR) and 30 min of spontaneous recirculation. The CPR protocol included closed-chest cardiac massage, administration of epinephrine 0.2 mg/kg, bicarbonate 2 mEq/kg per 30 min, and electrical defibrillation shocks. Interventions: During CPR, animals in the treatment group (n=6) received intravenous bolus injections of 100 U/kg heparin and 1 mg/kg recombinant tissue type plasminogen activator (rt-PA), followed by an infusion of rt-PA 1 mg/kg per 30 min. Measurements and results: Microcirculatory reperfusion of the brain was visualized by labeling the circulating blood with 300 mg/kg of 15% fluorescein isothiocyanate albumin at the end of the recirculation period. Areas of cerebral no-reflow – defined as the absence of microvascular filling – were identified by fluorescence microscopy at eight standard coronal levels of forebrain, and expressed as the percentage of total sectional area. One animal in the treatment group was excluded from further analysis because of intracerebral hemorrhage due to brain injury during trepanation. Autopsy revealed the absence of intracranial, intrathoracic, or intra-abdominal bleeding in all the other animals. In untreated animals (n=8), no-reflow affected 28±13% of total forebrain sectional areas, and only 1 out of 8 animals showed homogenous reperfusion (i.e., no-reflow 〈15% of total forebrain sectional areas). Thrombolytic therapy (n=5) significantly reduced no-reflow to 7±5% of total forebrain sectional areas and all treated animals showed homogeneous reperfusion at the microcirculatory level. Conclusions: The present data demonstrate that thrombolytic therapy improves microcirculatory reperfusion of the cat brain when administered during reperfusion after cardiac arrest.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 3
    ISSN: 1432-1238
    Keywords: Key words Thermodilution cardiac output ; Continuous monitoring ; Postoperative intensive care ; Extubation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Commercially available semi-continuous cardiac output (SCCO) monitoring systems are based on the pulsed warm thermodilution technique. There is evidence that SCCO fails to correlate with standard intermittent bolus cardiac output (ICO) in clinical situations with thermal instability in the pulmonary artery. Furthermore, ventilation may potentially influence thermodilution measurements by enhanced respiratory variations in pulmonary artery blood temperature and by cyclic changes in venous return. Therefore, we evaluated the correlation, accuracy and precision of SCCO versus ICO measurements before and after extubation. Design: Prospective cohort study. Setting: Intensive care unit (ICU) of a university hospital. Patients and participants: 22 cardiac surgical ICU patients. Interventions: None. Measurements and results: SCCO and ICO data were obtained at nine postoperative time points while the patients were on controlled mechanical ventilation. Further sets of measurements were taken during the weaning phase 20 min before extubation, and 5 min, 20 min and 1 h after extubation. SCCO and ICO measurements yielded 286 data pairs with a range of 1.8–9.9 l/min for SCCO and 1.9–9.8 l/min for ICO. The correlation between SCCO and ICO was highly significant (r=0.92; p〈0.01), accompanied by a bias of –0.052 l/min and a precision of 0.56 l/min. Correlation, accuracy and precision were not influenced by the mode of respiration. Conclusions: Our results demonstrate excellent correlation, accuracy and precision between SCCO and ICO measurements in postoperative cardiac surgical ICU patients. We conclude that SCCO monitoring offers a reliable clinical method of cardiac output monitoring in ICU patients following cardiac surgery.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 4
    ISSN: 1432-1238
    Keywords: Thermodilution cardiac output ; Continuous monitoring ; Postoperative intensive care ; Extubation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective Commercially available semi-continuous cardiac output (SCCO) monitoring systems are based on the pulsed warm thermodilution technique. There is evidence that SCCO fails to correlate with standard intermittent bolus cardiac output (ICO) in clinical situations with thermal instability in the pulmonary artery. Furthermore, ventilation may potentially influence thermodilution measurements by enhanced respiratory variations in pulmonary artery blood temperature and by cyclic changes in venous return. Therefore, we evaluated the correlation, accuracy and precision of SCCO versus ICO measurements before and after extubation. Design Prospective cohort study. Setting Intensive care unit (ICU) of a university hospital. Patients and participants 22 cardiac surgical ICU patients. Interventions None. Measurements and results SCCO and ICO data were obtained at nine postoperative time points while the patients were on controlled mechanical ventilation. Further sets of measurements were taken during the weaning phase 20 min before extubation, and 5 min, 20 min and 1 h after extubation. SCCO and ICO measurements yielded 286 data pairs with a range of 1.8–9.9 l/min for SCCO and 1.9–9.8 l/min for ICO. The correlation between SCCO and ICO was highly significant (r=0.92;p〈0.01), accompanied by a bias of −0.052 l/min and a precision of 0.56 l/min. Correlation, accuracy and precision were not influenced by the mode of respiration. Conclusions Our results demonstrate excellent correlation, accuracy and precision between SCCO and ICO measurements in postoperative cardiac surgical ICU patients. We conclude that SCCO monitoring offers a reliable clinical method of cardiac ouput monitoring in ICU patients following cardiac surgery.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Der Anaesthesist 43 (1994), S. 699-717 
    ISSN: 1432-055X
    Keywords: Schlüsselwörter: Anästhesie – Koronare Herzerkrankung – Myokardischämie – Medikamentöse Therapie –Übersicht ; Key words: Anaesthesia – Coronary heart disease – Myocardial ischaemia – Drug therapy – Review
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. Objective. The aim of our review is to summarize relevant data on the perioperative use of anti-ischaemic drugs in patients at risk for or with proven coronary heart disease. Data sources. The accessible medical literature according to current electronic information sources was explored. Results. One in every eight general anaesthetics is administered to a patient at risk for or with proven coronary heart disease. Of these patients, it is estimated that 20% – 40% have perioperative myocardial ischaemia (PMI), the majority being nonsymptomatic. This figure correlates with the occurrence of postoperative cardiac complications and myocardial infarction. The anaesthetist therefore has an important role to play in reducing the rate of perioperative cardiac sequelae. This can be achieved with good control of haemodynamic stability and the timely and appropriate use of antiischaemic drugs. Nitrocompounds (nitrates, molsidomine) serve as the gold standard in current angina pectoris treatment. Acting as coronary and systemic vasodilators, they effect an immediate reduction in preload and have been shown to be the drugs of first choice for intraoperative myocardial ischaemia. Beta-blockers reduce the rate of PMI to a greater extent than nitrates. They are also effective in myocardial ischaemia not accompanied by an increased heart rate. Single pre-operative administration of beta-blockers has also been shown to be beneficial in reducing theincidence of perioperative tachycardia, hypertension, and PMI. Consequently, such one-time medication can be considered for previously untreated high-risk patients presenting for surgery. The continuation of oral calcium channel blockers to the morning of surgery also reduces the rate of PMI and myocardial infarction in coronary-bypass patients, and combination with beta-blockers enhances this effect. Intra-operative diltiazem infusions are similarly advantageous in this patient group. In addition to nitrates, calcium antagonists are the drug of choice for coronary vasospasm. Drugs inhibiting platelet aggregation have a particular role in patients with coronary heart disease, however, they also cause increased perioperative bleeding. Consequently, it is recommended that these medications be discontinued 5 – 10 days prior to major surgery, with the exception of high-risk patients. Pilot studies using alpha2-agonists have shown reduced anaesthetic requirements and a reduction in PMI. The perioperative relevance of these drugs is currently being investigated. Conclusions. Beta-blockers, calcium channel blockers, nitrates, and possibly alpha2-agonists lead to reduced rates of PMI and other cardiac complications in risk patients. Current anti-anginal medications, with the exception of anti-platelet agents, should be maintained to the day of surgery and continued as soon as possible thereafter. All of these drugs except anti-platelet agents may also be used intra-operatively, however, possible interactions with anaesthetic agents should be carefully considered.
    Notes: Zusammenfassung. Jede 8. Anästhesie wird bei einem Patienten mit koronarer Herzerkrankung (KHK) bzw. bei Risikogruppen durchgeführt. Perioperativ finden sich bei diesen Patienten in 20 – 40% überwiegend klinisch stumme Myokardischämien. Diese korrelieren eindeutig mit der Rate postoperativer kardialer Komplikationen. Die Reduktion perioperativer kardialer Komplikationen ist eine wichtige Aufgabe des Anästhesisten. Neben einer hämodynamisch stabilen Führung kann dies durch den gezielten Einsatz antiischämischer Medikamente erreicht werden. NO-Donatoren (Nitrate, Molsidomin) bewirken eine koronare und systematische Gefäßdilatation mit konsekutiver akuter Verminderung der Füllungsdrucke. Bei intraoperativer Myokardischämie können Nitrate das Mittel der ersten Wahl darstellen. β-Blocker reduzieren die Ischämierate stärker als Nitrate. Sie wirken auch bei Ischämien, die nicht mit einem Anstieg der Herzfrequenz einhergehen und zeigen selbst bei einmaliger präoperativer Gabe günstige Effekte auf die perioperative Inzidenz von Hypertension, Tachykardien und Myokardischämien. Die Weiterführung einer chronischen oralen Therapie mit Kalziumantagonisten bis zum Morgen der Operation reduziert bei koronar-chirurgischen Patienten die Rate perioperativer Ischämien und Myokardinfarkte. β-Blocker verstärken diesen Effekt. Thrombozytenaggregationshemmer haben eine hohe prognostische Relevanz bei koronarkranken Patienten. Sie verursachen jedoch perioperativ eine signifikante Erhöhung der Blutungsrate. Von Hochrisikopatienten abgesehen wird daher das Absetzen dieser Substanzen 5 – 10 Tage vor einer größeren Operation empfohlen. Pilotstudien zeigen auch für α 2 -Agonisten eine Reduktion der Rate perioperativer Myokardischämien. Schlußfolgerung: β-Blocker, Kalziumantagonisten, NO-Donatoren und wahrscheinlich auch α 2-Antagonisten können bei Risikogruppen die Rate perioperativer Myokardischämien und folgender kardialer Komplikationen reduzieren. Eine chronische, antianginöse Medikation sollte daher mit Ausnahme der Thrombozytenaggregationshemmer bis zum Tag der Operation und postoperativ so früh als möglich weitergeführt werden. Bei einem intraoperativen Einsatz sind Interaktionen mit Anästhetika zu beachten.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Der Anaesthesist 49 (2000), S. 174-186 
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Koronare Herzerkrankung ; Perioperative Myokardischämie ; Operationsrisiko ; Medikamentöse Therapie ; Key words Coronary artery disease ; Perioperative myocardial ischemia ; Surgery ; Patient safety ; Drug therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Perioperative cardiac morbidity and mortality are a major health care challenge with important individual as well as economic aspects. Up to 30% of all perioperative complications and up to 50% of all postoperative deaths are related to cardiac causes. Perioperative myocardial ischemia, which occurs in more than 40% of patients with or at risk for coronary artery disease and undergoing noncardiac surgery, represents a dynamic predictor of postoperative cardiac complications. Long-duration myocardial ischemia and ischemic episodes associated with myocardial cell damage are particularly of prognostic relevance. In patients suffering from this type of ischemia, the incidence of adverse cardiac outcome is increased up to 20-fold. Reducing the incidence of perioperative myocardial ischemia is associated with a decrease in adverse cardiac outcome. Important issues related to perioperative myocardial ischemia are hematocrit level, body temperature, and hemodynamic variables. In contrast, the choice of anesthetic agents and techniques appears to be less important. Perioperative administration of anti-ischemic drugs in patients at risk, however, leads to a further decrease in the incidence of myocardial ischemia and to an improvement in patient outcome. Recent studies suggest that alpha2- agonists and particularly beta-adrenoreceptor blocking agents are effective anti-ischemic drugs in the perioperative setting. Perioperative administration of beta-adrenoreceptor blocking agents in coronary risk patients undergoing noncardiac surgery is associated with a reduced rate of postoperative cardiac complications and an improvement in long-term outcome. This is particularly relevant in high risk patients with preoperative stress-induced ischemic episodes. In clinical practice, therefore, chronically administered anti-ischemic drugs should also be administered on the day of surgery and during the postoperative period. In untreated patients with or at risk for coronary artery disease and who have to undergo urgent surgical procedures without the opportunity of preoperative anti-ischemic intervention, perioperative administration of beta-adrenoreceptor blocking agents is mandatory.
    Notes: Zusammenfassung Die perioperative kardiale Morbidität und Mortalität bei Patienten mit koronarer Herzerkrankung stellt ein individuell und volkswirtschaftlich bedeutsames Gesundheitsproblem dar. Bis zu 30% aller perioperativen Komplikationen und bis zu 50% aller postoperativen Todesfälle sind auf kardiale Ursachen zurückzuführen. Perioperative Myokardischämien, die bei mehr als 40% aller koronaren Risikopatienten im Zusammenhang mit einem nichtherzchirurgischen Eingriff zu beobachten sind, gelten als dynamische Prädiktoren postoperativer kardialer Komplikationen. Dabei sind insbesondere längerdauernde bzw. mit einer myokardialen Zellschädigung einhergehende Ischämien prognostisch relevant. Treten solche Ischämien auf, so ist die Rate kardialer Komplikationen um bis zu 20fach erhöht. Eine suffiziente Prävention von perioperativen Myokardischämien reduziert die kardiale Komplikationsrate. Entscheidende perioperative Regelgrößen in diesem Zusammenhang sind der Hämatokrit, die Körpertemperatur und die Hämodynamik. Die Wahl des Anästhesieverfahrens scheint insgesamt weniger von Bedeutung zu sein. Dagegen kann der Einsatz antiischämischer Medikamente zu einer weiteren Reduktion der Ischämierate und zu einer Verbesserung des Outcomes bei koronaren Risikopatienten beitragen. Aktuelle Studien zeigen, dass Alpha2-Agonisten und v.a. Beta-Rezeptorenblocker in diesem Zusammenhang effektiv sind. Eine perioperative Applikation von Beta-Rezeptorenblockern reduziert die postoperative kardiale Komplikationsrate und verbessert das langfristige Outcome nichtherzchirurgischer koronarer Risikopatienten. Dies gilt in besonderem Maße für Hochrisikopatienten mit präoperativer Belastungsischämie. Als Leitlinie für die klinische Praxis lässt sich feststellen, dass eine chronisch applizierte antiischämische Medikation auch am Tag der Operation und postoperativ so früh als möglich weitergeführt werden sollte. Bei unbehandelten koronaren Risikopatienten, die dringlich operiert werden müssen, sollte – neben einem erweiterten perioperativen Monitoring – die prophylaktische Applikation eines Beta-Rezeptorenblockers angestrebt werden.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 7
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In 25 cardiac surgical patients, right ventricular ejection fraction was continuously measured with a new pulmonary artery catheter and transoesophageal echocardiography, scanning the ‘fractional area change’ in a standardised transatrial cross section area. Measurements were recorded at three predefined time points (pre-, intra-, and postoperatively). Both methods were compared using the Bland-Altman analysis. Comparing right ventricular ejection fraction values obtained from the pulmonary artery catheter with those assessed by transoesophageal echocardiography, bias was −3.7%, with a precision of 30.9%. Bias and precision significantly improved when the heart rate was less than 100 beats.min−1, pulmonary artery pressures were low and cardiac performance adequate. In conclusion, the new continuous pulmonary artery catheter system appears to be a valid and useful bedside monitoring device in the haemodynamic management of critically ill patients.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 8
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 9
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Formation of the lignocaine metabolite monoethyl-glycine-xylidide (MEGX) by hepatic cytochrome P450 enzymes is a new method for evaluating liver function. The purpose of this study was to compare MEGX formation with other liver function parameters in surgical intensive care unit patients. The study included 29 critically ill patients who had been admitted to the unit for more than 3 days with a median APACHE III score-predicted mortality 〉 30%. On day 4, lignocaine was given intravenously at a dose of 1 mg.kg-1 over 2 min and MEGX formation was measured 15 min later. Eighty-nine percent of the patients had MEGX values below 90μg.l-1 indicating impaired liver function. Eleven patients died, 18 patients survived. The group of patients with fatal outcome had significantly lower MEGX values (median: 23μg.l-1) than the group of survivors (median: 53μg.l-1, p 〈 0.01). Bilirubin values were elevated in the non-survivor group (median: 2.8mg.dl-1) compared to the survivors (median: 0.9mg.dl-1, p 〈 0.05). There was no significant difference between the two groups in the other liver function tests. We conclude from our results that the MEGX test can be considered an indicator for hepatic dysfunction and predictor of survival in critically ill patients.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 10
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We investigated the association of peri-operative myocardial ischaemia with activation of coagulation and endogenous fibrinolysis in patients undergoing vascular surgery. In 50 patients, continuous Holter monitoring was performed to assess peri-operative myocardial ischaemia and 12-lead electrocardiography was recorded preoperatively and 72 h postoperatively to assess myocardial infarction. Serial blood samples were drawn peri-operatively to determine the concentrations of fibrin monomers (for activation of coagulation), d-dimer (for endogenous fibrinolysis) and cardiac troponin T and I. Patients with myocardial ischaemia showed higher concentrations of fibrin monomers at 48 h, and higher concentrations of d-dimer preoperatively and at 24 and 48 h postoperatively. In patients with peri-operative myocardial ischaemia, strong positive correlations were observed between fibrin monomer and d-dimer concentrations at 15 min and 4 h postoperatively, and cardiac troponins at 15 min and at 4, 24, 48 and 72 h postoperatively. Early postoperative activation of coagulation and fibrinolysis is associated with peri-operative myocardial cell damage among patients who are at risk for, or have a history of, coronary artery disease plus peri-operative myocardial ischaemia.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...