The course of 225 multiple traumatized patients in our ICU with a mean age of 35 +/- 16.8 years, a mean ISS of 30 +/- 8.3 and an overall mortality of 18.2% was evaluated retrospectively. For comparable ISS the mortality was higher in patients over 65 years, and increased further with age. The most common causes of death were MOF (41.5%), severe head injury (34.1%), and acute respiratory failure (ARF) (19.5%). The mortality increased when two or more organ failures were present. 105 patients had fractures of the long bones; in 28 of these all fractures were stabilized primarily (during the first 24 hours). Organ failure was seen less frequently in these patients compared to those with secondary stabilization: ARF 10.7% vs. 51.9% (p less than 0.0004), acute renal failure 3.6% vs. 11.7%, liver failure 3.6% vs. 11.7%, sepsis 14.3% vs. 29.9%. Mortality was significantly lower in the patient with primarily stabilized fractures (7.1% vs. 24.7%, p less than 0.05). The study demonstrates that early stabilization of long bone fractures results in a more favourable course, and that this should be carried out whenever feasible.
{"title":"[Organ failure in patients with multiple trauma. The effect of early osteosynthesis of fractures on complications].","authors":"H Burchardi, M Sydow, T A Crozier, J Burgdorff","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The course of 225 multiple traumatized patients in our ICU with a mean age of 35 +/- 16.8 years, a mean ISS of 30 +/- 8.3 and an overall mortality of 18.2% was evaluated retrospectively. For comparable ISS the mortality was higher in patients over 65 years, and increased further with age. The most common causes of death were MOF (41.5%), severe head injury (34.1%), and acute respiratory failure (ARF) (19.5%). The mortality increased when two or more organ failures were present. 105 patients had fractures of the long bones; in 28 of these all fractures were stabilized primarily (during the first 24 hours). Organ failure was seen less frequently in these patients compared to those with secondary stabilization: ARF 10.7% vs. 51.9% (p less than 0.0004), acute renal failure 3.6% vs. 11.7%, liver failure 3.6% vs. 11.7%, sepsis 14.3% vs. 29.9%. Mortality was significantly lower in the patient with primarily stabilized fractures (7.1% vs. 24.7%, p less than 0.05). The study demonstrates that early stabilization of long bone fractures results in a more favourable course, and that this should be carried out whenever feasible.</p>","PeriodicalId":7813,"journal":{"name":"Anasthesie, Intensivtherapie, Notfallmedizin","volume":"25 1","pages":"64-71"},"PeriodicalIF":0.0,"publicationDate":"1990-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13460160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mixed venous oxygen saturation (SvO2) has been established as a useful guide in observing whole body oxygenation. Since SvO2 provides limited information about adequate tissue oxygenation for a specific organ, the usefulness of central venous saturation (ScvO2) as a guide was analysed, which is a less invasive parameter. In 19 ICU patients 44 pairs of blood samples were drawn from a separate central venous catheter and from the tip of an SG-catheter. The correlation of oxygen partial pressures was 0.687 and the correlation of the saturation reached 0.779. The calculation of venous admixture showed a correlation of 0.901. It is concluded that ScvO2 yields adequate information on the oxygen saturation of venous return.
{"title":"[Mixed venous versus central venous oxygen saturation in intensive medicine].","authors":"M Wendt, T Hachenberg, A Albert, R Janzen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Mixed venous oxygen saturation (SvO2) has been established as a useful guide in observing whole body oxygenation. Since SvO2 provides limited information about adequate tissue oxygenation for a specific organ, the usefulness of central venous saturation (ScvO2) as a guide was analysed, which is a less invasive parameter. In 19 ICU patients 44 pairs of blood samples were drawn from a separate central venous catheter and from the tip of an SG-catheter. The correlation of oxygen partial pressures was 0.687 and the correlation of the saturation reached 0.779. The calculation of venous admixture showed a correlation of 0.901. It is concluded that ScvO2 yields adequate information on the oxygen saturation of venous return.</p>","PeriodicalId":7813,"journal":{"name":"Anasthesie, Intensivtherapie, Notfallmedizin","volume":"25 1","pages":"102-6"},"PeriodicalIF":0.0,"publicationDate":"1990-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13460157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C Anger, T van Bömmel, S Phadana-anek, A Reich, J Büter, H Stahl, T Deitmer
Changes in relative humidity and temperature of the anaesthetic gases were measured in the inspiratory limb of the Dräger circle system next to the carbon dioxide absorber in 29 patients requiring ENT surgery under general anaesthesia. Immediately following intubation and prior to extubation, nasal and tracheal cytologic samples were taken with a brush technique and ciliary beat frequency was determined. At a fresh gas flow of 6 l/min, relative humidity increased from 57.6 +/- 1.5 to 62.5 +/- 1.8% (p less than 0.05) after 110 minutes. Temperature increased continuously from 21.96 +/- 0.97 degrees C to 23.83 +/- 0.48 degrees C after 200 minutes. The number of vital ciliated cells in the tracheal samples decreased from 24.4% following induction of anaesthesia to 6% at the end of anaesthesia (p less than 0.05), and from 35.7% to 26.8% (p less than 0.05) in the nasal samples. Ciliary beat frequency remained unchanged at the end of anaesthesia as compared to control in tracheal as well as in nasal samples. It is concluded that the output of relative humidity and temperature in the circle system is not sufficient to prevent broncho-epithelial damage. Ciliary beat automaticity appears to behave according to an all or nothing principle.
{"title":"[Characteristics of the relative humidity and temperature in the inspiratory part of the Dräger circle system and their influence on the function of the ciliary epithelium].","authors":"C Anger, T van Bömmel, S Phadana-anek, A Reich, J Büter, H Stahl, T Deitmer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Changes in relative humidity and temperature of the anaesthetic gases were measured in the inspiratory limb of the Dräger circle system next to the carbon dioxide absorber in 29 patients requiring ENT surgery under general anaesthesia. Immediately following intubation and prior to extubation, nasal and tracheal cytologic samples were taken with a brush technique and ciliary beat frequency was determined. At a fresh gas flow of 6 l/min, relative humidity increased from 57.6 +/- 1.5 to 62.5 +/- 1.8% (p less than 0.05) after 110 minutes. Temperature increased continuously from 21.96 +/- 0.97 degrees C to 23.83 +/- 0.48 degrees C after 200 minutes. The number of vital ciliated cells in the tracheal samples decreased from 24.4% following induction of anaesthesia to 6% at the end of anaesthesia (p less than 0.05), and from 35.7% to 26.8% (p less than 0.05) in the nasal samples. Ciliary beat frequency remained unchanged at the end of anaesthesia as compared to control in tracheal as well as in nasal samples. It is concluded that the output of relative humidity and temperature in the circle system is not sufficient to prevent broncho-epithelial damage. Ciliary beat automaticity appears to behave according to an all or nothing principle.</p>","PeriodicalId":7813,"journal":{"name":"Anasthesie, Intensivtherapie, Notfallmedizin","volume":"25 1","pages":"107-11"},"PeriodicalIF":0.0,"publicationDate":"1990-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13460158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H Van Aken, J Van Hemelrijck, L Merckx, T Möllhoff, J Mulier, H J Lübbesmeyer
Anaesthesia for neurosurgical patients should provide haemodynamic stability, reduce cerebral metabolism, preserve cerebral autoregulation, avoid increases of intracranial pressure and guarantee rapid recovery without respiratory depression. A commonly used Balanced Anaesthesia (BA, n = 20) (thiopental and fentanyl bolus induction and maintenance with repetition boluses of fentanyl and droperidol, thiopental infusion, and isoflurane in N2O/O2) was compared to Total Intravenous Anaesthesia (TIVA, n = 20) with propofol and alfentanil infusion. Pancuronium was employed for muscle relaxation in both groups. The TIVA evinced more haemodynamic stability during induction; notably, there was no increase in blood pressure after intubation, as seen in the BA group. Another advantage of TIVA is that it obviates the use of N2O. Quality of recovery after the procedure was determined by standardised psychometric tests. The time span between awakening of patients to orientation and concentration was significantly shorter in the TIVA group compared to the BA group. There was also a smaller deviation of these parameters in the TIVA group indicating a more predictable recovery.
神经外科患者的麻醉应保证血流动力学稳定,减少脑代谢,保持大脑自身调节,避免颅内压升高,保证快速恢复,无呼吸抑制。将一种常用的平衡麻醉(BA, n = 20)(硫喷妥钠和芬太尼丸诱导和维持,芬太尼和哌啶醇重复剂量,硫喷妥钠输注,异氟醚在N2O/O2中)与丙泊酚和阿芬太尼输注全静脉麻醉(TIVA, n = 20)进行比较。两组均应用泮库溴铵进行肌肉松弛。在诱导过程中,TIVA表现出更强的血流动力学稳定性;值得注意的是,与BA组相比,插管后血压没有升高。TIVA的另一个优点是它避免了N2O的使用。手术后的恢复质量由标准化心理测试确定。与BA组相比,TIVA组患者对定向和集中的觉醒时间间隔明显缩短。在TIVA组中,这些参数的偏差也较小,表明恢复更可预测。
{"title":"[Total intravenous anesthesia using propofol and alfentanil in comparison with balanced anesthesia in neurosurgery].","authors":"H Van Aken, J Van Hemelrijck, L Merckx, T Möllhoff, J Mulier, H J Lübbesmeyer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Anaesthesia for neurosurgical patients should provide haemodynamic stability, reduce cerebral metabolism, preserve cerebral autoregulation, avoid increases of intracranial pressure and guarantee rapid recovery without respiratory depression. A commonly used Balanced Anaesthesia (BA, n = 20) (thiopental and fentanyl bolus induction and maintenance with repetition boluses of fentanyl and droperidol, thiopental infusion, and isoflurane in N2O/O2) was compared to Total Intravenous Anaesthesia (TIVA, n = 20) with propofol and alfentanil infusion. Pancuronium was employed for muscle relaxation in both groups. The TIVA evinced more haemodynamic stability during induction; notably, there was no increase in blood pressure after intubation, as seen in the BA group. Another advantage of TIVA is that it obviates the use of N2O. Quality of recovery after the procedure was determined by standardised psychometric tests. The time span between awakening of patients to orientation and concentration was significantly shorter in the TIVA group compared to the BA group. There was also a smaller deviation of these parameters in the TIVA group indicating a more predictable recovery.</p>","PeriodicalId":7813,"journal":{"name":"Anasthesie, Intensivtherapie, Notfallmedizin","volume":"25 1","pages":"54-8"},"PeriodicalIF":0.0,"publicationDate":"1990-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13460159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 16 consecutive patients with diffuse peritonitis 93 staged lavages were undertaken. In a retrospective study the changes of some vital functions due to transport in the operating room and staged lavage were evaluated. 9 patients (56%) survived the diffuse peritonitis. The vital parameters showed no significant changes following staged lavages. Intraabdominal specimen cultures were positive in 62% of cases, showing no correlation of the underlying disease and mortality. Only an elevation of C-reactive protein and rise of thrombocyte count correlated significantly with the outcome of diffuse peritonitis.
{"title":"[The effect of staged lavages in peritonitis on the vital functions].","authors":"E Götz, S Bogosyan, D Loose","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In 16 consecutive patients with diffuse peritonitis 93 staged lavages were undertaken. In a retrospective study the changes of some vital functions due to transport in the operating room and staged lavage were evaluated. 9 patients (56%) survived the diffuse peritonitis. The vital parameters showed no significant changes following staged lavages. Intraabdominal specimen cultures were positive in 62% of cases, showing no correlation of the underlying disease and mortality. Only an elevation of C-reactive protein and rise of thrombocyte count correlated significantly with the outcome of diffuse peritonitis.</p>","PeriodicalId":7813,"journal":{"name":"Anasthesie, Intensivtherapie, Notfallmedizin","volume":"25 1","pages":"83-6"},"PeriodicalIF":0.0,"publicationDate":"1990-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13460163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The majority of modern anaesthetic machines is designed for the rebreathing method. But frequently high fresh gas flows are employed, thus minimising the rebreathing fraction of expiratory gases. However, only by reducing the fresh gas flow substantially, the advantages of the rebreathing technique can be obtained. To evaluate the practicability of flow reduction, minimal flow anaesthesia was carried out with four different anaesthetic machines: AV 1 (Drägerwerk AG, Lübeck), ELSA (Gambro Engström AB, Bromma, Sweden), SULLA 808 V (Drägerwerk AG, Lübeck) und VIVOLEC (Hoyer Medizintechnik, Bremen). Fresh gas flow was reduced to 0.5 l/min after an initial phase of 15-20 min, during which the fresh gas flow was kept at a high level of 4.4 l/min. The minute volumes before and after fresh gas flow reduction were compared. The minute volume decreased markedly and significantly in the SULLA 808 group, whereas it remained nearly unchanged in the AV 1, the ELSA, and the VIVOLEC groups. The differences result from different modes of fresh gas delivery into the breathing circuit. If anaesthetic apparatus that maintain their tidal volume with different fresh gas flow rates are employed, rebreathing systems may be used judiciously by changing the fresh gas flow according to the individual uptake or any particular clinical requirement.
大多数现代麻醉机都是为再呼吸法设计的。但通常采用高新鲜气体流量,从而尽量减少呼气气体的再呼吸部分。然而,只有大幅度减少新鲜气体流量,才能获得再呼吸技术的优点。为了评估流量减少的实用性,使用四种不同的麻醉机进行最小流量麻醉:AV 1 (Drägerwerk AG, l beck), ELSA (Gambro Engström AB,瑞典Bromma), SULLA 808 V (Drägerwerk AG, l beck)和VIVOLEC (Hoyer Medizintechnik,不来梅)。初始阶段15-20 min后,新鲜气体流量降至0.5 l/min,在此期间新鲜气体流量保持在4.4 l/min的高位。比较了新鲜气体减少前后的分钟体积。sula 808组的分钟体积明显下降,而av1、ELSA和VIVOLEC组的分钟体积几乎保持不变。这种差异是由于新鲜气体进入呼吸回路的方式不同造成的。如果使用的麻醉装置以不同的新鲜气体流速保持其潮汐量,则可根据个人摄取或任何特定的临床要求,明智地通过改变新鲜气体流量来使用再呼吸系统。
{"title":"[Fresh gas flow and artificial respiration in anesthesia. Technical requirements for the adequate use of rebreathing systems].","authors":"J Baum, G Sachs","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The majority of modern anaesthetic machines is designed for the rebreathing method. But frequently high fresh gas flows are employed, thus minimising the rebreathing fraction of expiratory gases. However, only by reducing the fresh gas flow substantially, the advantages of the rebreathing technique can be obtained. To evaluate the practicability of flow reduction, minimal flow anaesthesia was carried out with four different anaesthetic machines: AV 1 (Drägerwerk AG, Lübeck), ELSA (Gambro Engström AB, Bromma, Sweden), SULLA 808 V (Drägerwerk AG, Lübeck) und VIVOLEC (Hoyer Medizintechnik, Bremen). Fresh gas flow was reduced to 0.5 l/min after an initial phase of 15-20 min, during which the fresh gas flow was kept at a high level of 4.4 l/min. The minute volumes before and after fresh gas flow reduction were compared. The minute volume decreased markedly and significantly in the SULLA 808 group, whereas it remained nearly unchanged in the AV 1, the ELSA, and the VIVOLEC groups. The differences result from different modes of fresh gas delivery into the breathing circuit. If anaesthetic apparatus that maintain their tidal volume with different fresh gas flow rates are employed, rebreathing systems may be used judiciously by changing the fresh gas flow according to the individual uptake or any particular clinical requirement.</p>","PeriodicalId":7813,"journal":{"name":"Anasthesie, Intensivtherapie, Notfallmedizin","volume":"25 1","pages":"72-8"},"PeriodicalIF":0.0,"publicationDate":"1990-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13460161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Computer-aided documentation of medical and performance data processing seems to be imperative for every intensive-care unit in the future. It is the rational approach to deal with therapy-related information management as well as organizational and administrative tasks. This custom-made program is based on data collected from 3600 intensive-care patients. It serves 3 objectives: 1. documentation of relevant therapeutic data, 2. information exchange with other departments, 3. thorough analysis of topics related to intensive-care medicine. Based on a microsoft disc operating system, the programme contains not only the data base but also word processing and statistical capacities. Optional choice by menu guarantees easy handling and helps to create a high acceptance.
{"title":"[Computer-assisted documentation and performance data processing in the intensive care unit. Description of a custom development].","authors":"H N Herden, A Tecklenburg","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Computer-aided documentation of medical and performance data processing seems to be imperative for every intensive-care unit in the future. It is the rational approach to deal with therapy-related information management as well as organizational and administrative tasks. This custom-made program is based on data collected from 3600 intensive-care patients. It serves 3 objectives: 1. documentation of relevant therapeutic data, 2. information exchange with other departments, 3. thorough analysis of topics related to intensive-care medicine. Based on a microsoft disc operating system, the programme contains not only the data base but also word processing and statistical capacities. Optional choice by menu guarantees easy handling and helps to create a high acceptance.</p>","PeriodicalId":7813,"journal":{"name":"Anasthesie, Intensivtherapie, Notfallmedizin","volume":"25 1","pages":"79-82"},"PeriodicalIF":0.0,"publicationDate":"1990-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13460162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J L Theissen, K Redmann, P P Lunkenheimer, G Grosskopff, R E Zimmermann, P Lawin
Dangers of high-frequency ventilation result from the lack of a sensitive monitoring technique. Mucosal lesions of the trachea and the bronchi as well as cooling of the patient can be prevented by adequate humidification and heating of the gas flow. It is still controversial whether HFV leads to increased mucus production or secretolysis, and whether it prevents or promotes aspiration. The influence of mobilisation or immobilisation of a pulmonary focus on its recovery is not well understood. Interferences of HFV with the autonomic nervous system and endocrine system, like an increased release of PGI2, an antidiuretic and narcotic effect, with the coagulation system and the acid-base balance are inconsistent and therefore need particular clinical observation.
{"title":"[High-frequency ventilation: side effects and dangers].","authors":"J L Theissen, K Redmann, P P Lunkenheimer, G Grosskopff, R E Zimmermann, P Lawin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Dangers of high-frequency ventilation result from the lack of a sensitive monitoring technique. Mucosal lesions of the trachea and the bronchi as well as cooling of the patient can be prevented by adequate humidification and heating of the gas flow. It is still controversial whether HFV leads to increased mucus production or secretolysis, and whether it prevents or promotes aspiration. The influence of mobilisation or immobilisation of a pulmonary focus on its recovery is not well understood. Interferences of HFV with the autonomic nervous system and endocrine system, like an increased release of PGI2, an antidiuretic and narcotic effect, with the coagulation system and the acid-base balance are inconsistent and therefore need particular clinical observation.</p>","PeriodicalId":7813,"journal":{"name":"Anasthesie, Intensivtherapie, Notfallmedizin","volume":"25 Suppl 1 ","pages":"14-9"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13332728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We studied 22 critically ill patients on long-term mechanical ventilation using continuous intragastric pH monitoring with an antimony electrode. Intragastric pH profiles were established for the duration of mechanical ventilation (mean: 7 days). The aim of our study was to achieve a gastric pH between 3.0 and 4.5 utilizing the H2-receptor antagonist ranitidine and nasogastric feeding with Nutricomp F. Patients were divided into three groups which were given (A) ranitidine boluses, (B) continuous ranitidine infusions, or (C) continuous ranitidine infusions together with enteral nutrition via the nasogastric tube. In group B we were able to obtain a pH value between 3.0 and 4.5 only in 11.6% of the observation period. With ranitidine boluses, there were even less measurements (9.3%) in the "optimal" pH range. The combination of continuous ranitidine application together with enteral alimentation made our attempts slightly more successful (20.0%). This failure to achieve the desired pH range encourages airway colonisation and nosocomial pneumonia at gastric pH greater than 4.5. At pH less than 3.0 there is a significantly higher incidence of acute stress ulcerations. Other therapeutic regimens e.g. the application of pirenzepine and sucralfate offer adequate protection of the gastric mucosa without raising the pH level.
{"title":"[Continuous intragastric pH measurement in intensive care patients treated with ranitidine and tube feeding].","authors":"C Krier, H Böhrer, G Jürs, S Warth, O H Just","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We studied 22 critically ill patients on long-term mechanical ventilation using continuous intragastric pH monitoring with an antimony electrode. Intragastric pH profiles were established for the duration of mechanical ventilation (mean: 7 days). The aim of our study was to achieve a gastric pH between 3.0 and 4.5 utilizing the H2-receptor antagonist ranitidine and nasogastric feeding with Nutricomp F. Patients were divided into three groups which were given (A) ranitidine boluses, (B) continuous ranitidine infusions, or (C) continuous ranitidine infusions together with enteral nutrition via the nasogastric tube. In group B we were able to obtain a pH value between 3.0 and 4.5 only in 11.6% of the observation period. With ranitidine boluses, there were even less measurements (9.3%) in the \"optimal\" pH range. The combination of continuous ranitidine application together with enteral alimentation made our attempts slightly more successful (20.0%). This failure to achieve the desired pH range encourages airway colonisation and nosocomial pneumonia at gastric pH greater than 4.5. At pH less than 3.0 there is a significantly higher incidence of acute stress ulcerations. Other therapeutic regimens e.g. the application of pirenzepine and sucralfate offer adequate protection of the gastric mucosa without raising the pH level.</p>","PeriodicalId":7813,"journal":{"name":"Anasthesie, Intensivtherapie, Notfallmedizin","volume":"25 Suppl 1 ","pages":"10-3"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13262155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J Scholz, F Bednarz, N Roewer, R Schmidt, J Schulte am Esch
8 ASA class II-III patients (50-67 years) undergoing traumatic-surgical procedures were studied. Since the release of atrial natriuretic peptide (ANP) is stimulated by volume loading and increased right atrial pressure (RAP), the effects of incremental positive end-expiratory pressure (PEEP) on ANP-concentration, RAP and right atrial dimensions were investigated. Anaesthesia was induced with intravenous etomidate and vecuronium and maintained after endotracheal intubation with 66% N2O in O2 and ethrane (0.4-0.6 Vol.-%). A catheter was inserted into the A. radialis for blood sampling and determination of mean arterial pressure (MAP). For determining endsystolic (RAESA) and end-diastolic (RAEDA) areas of the right atrium a 5 MHz transoesophageal echocardiographic (TEE)-probe was positioned at the level of the foramen ovale. Under TEE-control a catheter was placed into the right atrium for measurement of RAP. The method for ANP determination was based on a direct radioimmunoassay that is specific for human ANP (ANP-J125). PEEP was incrementally raised from 0 to 16 mbar in 4 mbar steps each for 5 min and thereafter reduced to 0 mbar. During the investigation no significant differences were detectable for MAP, heart rate, end-expiratory CO2 partial pressure and the arterial O2 saturation. However, 16 mbar PEEP ventilation increased plasma ANP concentrations (from 44.3 +/- 9.7 to 58.1 +/- 8.7 pg/ml) and RAP (from 4.4 +/- 0.9 to 10.7 +/- 0.9 mmHg) whereas the right atrial dimensions RAESA (from 9.4 +/- 1.0 to 4.6 +/- 0.6 cm2) and RAEDA (from 5.9 +/- 1.2 to 3.2 +/- 0.4 cm2) decreased.(ABSTRACT TRUNCATED AT 250 WORDS)
{"title":"[The effects of incremental PEEP on atrial natriuretic peptide, right atrial pressure and the size of the right atrium in anesthetized patients].","authors":"J Scholz, F Bednarz, N Roewer, R Schmidt, J Schulte am Esch","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>8 ASA class II-III patients (50-67 years) undergoing traumatic-surgical procedures were studied. Since the release of atrial natriuretic peptide (ANP) is stimulated by volume loading and increased right atrial pressure (RAP), the effects of incremental positive end-expiratory pressure (PEEP) on ANP-concentration, RAP and right atrial dimensions were investigated. Anaesthesia was induced with intravenous etomidate and vecuronium and maintained after endotracheal intubation with 66% N2O in O2 and ethrane (0.4-0.6 Vol.-%). A catheter was inserted into the A. radialis for blood sampling and determination of mean arterial pressure (MAP). For determining endsystolic (RAESA) and end-diastolic (RAEDA) areas of the right atrium a 5 MHz transoesophageal echocardiographic (TEE)-probe was positioned at the level of the foramen ovale. Under TEE-control a catheter was placed into the right atrium for measurement of RAP. The method for ANP determination was based on a direct radioimmunoassay that is specific for human ANP (ANP-J125). PEEP was incrementally raised from 0 to 16 mbar in 4 mbar steps each for 5 min and thereafter reduced to 0 mbar. During the investigation no significant differences were detectable for MAP, heart rate, end-expiratory CO2 partial pressure and the arterial O2 saturation. However, 16 mbar PEEP ventilation increased plasma ANP concentrations (from 44.3 +/- 9.7 to 58.1 +/- 8.7 pg/ml) and RAP (from 4.4 +/- 0.9 to 10.7 +/- 0.9 mmHg) whereas the right atrial dimensions RAESA (from 9.4 +/- 1.0 to 4.6 +/- 0.6 cm2) and RAEDA (from 5.9 +/- 1.2 to 3.2 +/- 0.4 cm2) decreased.(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":7813,"journal":{"name":"Anasthesie, Intensivtherapie, Notfallmedizin","volume":"25 Suppl 1 ","pages":"20-4"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13293070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}