Praktische Anasthesie, Wiederbelebung und Intensivtherapie最新文献

The classification of the radiological features of the "shock lung" into stages represents a description of the characteristic radiological changes as they develop in the course of the lesion. As these changes do not succeed each other step by step but are superimposed their attribution to a particular stage therefore describes only the dominant substrate. Since the radiological changes and the corresponding oxygen tensions generally show satisfactory correlation a lack of correspondence during treatment may be an early sign of secondary disturbances or complications.

A new apparatus is described for the continuous on-line estimation of the concentration of anaesthetic vapours. The results obtained with the apparatus for halothane were compared with those registered by a mass spectrometer; there was excellent agreement (r = 0.999). The equipment is very manageable and has already proved its value is anaesthetic practice.

Chest roentgenography of artificially ventilated persons not only reveals morphological changes in the lungs but may also provide information regarding their pathogenesis and prognosis. To safeguard against misinterpretation of the findings they should be supplemented by blood gas analyses and function tests (e.g. effective compliance of the respiratory system). The chest roentgenogram also apprises of the development, and consequently of the need for treatment, of such complications as interstital emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum and subcutaneous emphysema.

The radiological changes and clinical symptoms induced by in 109 persons by inhalation of irritant gases are described. Seven persons developed pulmonary oedema, abnormal radiological manifestations were observed in 19 while 81 persons there were no detectable radiological changes. Toxic pulmonary oedema is frequently detected earlier by roentgenologic means than clinically. The length of the radiological latent period depends not only on the concentration of the irritant but also on the type of the gaseous substance. The first roentgenologic signs of toxic pulmonary oedema are broadening and blurring of the outline of the hilar vessels. The pulmonary changes are characterized initially by disseminated small to medium sized shadows in the central portion and base of the lungs; later they tend to spread and merge.

The increasing demands made by intensive care medicine on chest and abdominal radiography and on angiography have created the need for new X-ray equipment that combines short exposure with high tension. Battery-operated medium-frequency generators have an adequate output to satisfy these demands. For visualizing peripheral vessels in intensive care patients xeroradiographic arteriography has proved its value.

Chest roentgenograms made within 24 hours of death were compared to the autopsy findings. Out of 150 unselected autopsy records of the years 1973/74 and 1976/77 50 and 91 cases respectively were suitable for evaluation. Since 1973/74 the radiographic technique has been considerably changed by the introduction of powerful condenser discharge equipment and the use of highly intensifying screens. Daily discussions with the physicians in charge of the intensive care unit and routine comparison of the pathological and radiological findings were also introduced. The success of these measures is reflected in the greater diagnostic accuracy in respect of the case material for the 1976/77 period. Comparison of the findings in cases of pulmonary embolism exposed the limitation of diagnostic radiology.

Ventilation with increased end-exspiratory pressure may, especially in cases of blunt chest trauma, result in pneumoperitoneum although there are no intestinal injuries. The case histories of four persons who developed this complication are reviewed. Differentiation between such a complication and a condition requiring laparotomy is often difficult because other injuries, particularly a cerebrocranial trauma, may obscure the clinical symptoms. Diagnostic peritoneal lavage may help towards differentiating between a ventilation-induced pneumoperitoneum and an "acute abdomen" caused by perforation or rupture of an intra-abdominal hallow organ.

A laryngoscope blade with an integrated suction tube is described. Suction and laryngoscope can be handled simultaneously by one hand. The suction guarantees a free sight during intubation in cases of bleeding in the nasopharyngeal region and may also prevent the aspiration of acid gastric contents.

The incidence of complications in a consecutive series of 515 abdominal surgical operations was studied. Abdominal complications of varying degree of severity were observed in 62 cases (16%). They were of four types: haemorrhage, ileus, peritonitis and complications on the part of the biliary tract and pancreas. The use of radiological methods for detecting these complications is reviewed. Direct roentgenography is the method of choice in cases of suspected ileus, perforation or foreign body. Administration of contrast media should be reserved almost entirely to cases of stress ulcer and to distinguish between incomplete and complete ileus. If perforation of penetration is suspected only water-soluble contrast media should be used. Detection of a leaking anastomosis or an abscess is by injection of the fistula. The value of angiography for revealing a haemorrhage or embolism and for assessing the response to vasoactive agents is discussed.

Chest X-rays of patients with respiratory insufficiency provide different information depending on the stage of the disease. The indications for chest radiography should, therefore, be determined by whether the examination is intended to establish the diagnosis and causes of the respiratory disease, to arrive at the differential diagnosis or test the efficacy of treatment.