Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Aug 1986
Comparative Study[High frequency jet ventilation in patients with acute respiratory failure. A comparison with conventional artificial respiration].
The major advantage of High Frequency Jet Ventilation (HFJV) in the treatment of patients with ARDS was commonly seen in better oxygenation and lower airway pressures, compared to conventional ventilation. Furthermore, HFJV seemed to be successful even in those patients in whom conventional ventilation had failed. We compared HFJV (f = 100/min, inspiratory time 40% to 50%) to conventional ventilation (f = 10/min, PEEP 5 to 10 cm H2O). ⋯ Pulmonary artery pressure (PAP 25.0 +/- 5.0 mmHg compared to 19.9 +/- 4.7 mmHg), central venous pressure (10.5 +/- 4.2 mmHg compared to 8.8 +/- 3.0 mmHg), pulmonary capillary pressure (13.3 +/- 4.4 mmHg compared to 11.3 +/- 3.7 mmHg), pulmonary vascular resistance (131.4 +/- 55.0 dyn . s . cm-5 compared to 96.7 +/- 33.7 dyn . s . cm-5) and right cardiac work index (1.38 +/- 0.55 kg . m/m2 compared to 1.05 +/- 0.33 kg . m/m2) were significantly increased (P less than 0.01) under HFJV. The other haemodynamic variables showed no difference between the two ventilatory modes. HFJV was inferior to conventional artificial ventilation in all patients and caused severe hypoxia in several patients, leading to pulmonary vasoconstriction and increased work of the right heart.(ABSTRACT TRUNCATED AT 250 WORDS)
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The accuracy of oxygen flowmeters is a prerequisite for a predictable oxygen therapy. As a flowmeter seems to be of unlimited service life, they are often not serviced regularly. This can result in errors in the actual oxygen flow of as much as 50% of the preset value.
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Anasth Intensivther Notfallmed · Aug 1986
[Airway pressure and transcutaneous O2 and CO2 partial pressure as monitoring measurements for high-frequency jet ventilation?].
Two different methods of measuring airway pressures (n = 7), and the usefulness of transcutaneous pO2 and pCO2 measurement (n = 9) in monitoring High Frequency Jet Ventilation (HFJV), were investigated in critically ill patients. Airway pressures obtained by tip manometer from different points within trachea and mainstem bronchi during HFJV (f = 100/min, inspiratory time 40%, FIO2 0,4, minute volume 25.6 +/- 5.2 l) were nearly identical with pressures obtained from the integrated pressure line of HI-LO-JET endotracheal tubes (R = 0.9638). ⋯ There was sufficient correlation between transcutaneous and arterial pO2 (R = 0.7573) and poor correlation between transcutaneous and arterial pCO2 (R = 0.4987). paO2 values were 51.1% above, paCO2 values 33.4% below transcutaneous values. Transcutaneous measurement of pO2 and pCO2 is only an additional method in monitoring HFJV which can reveal rough trends but cannot replace blood gas analysis.
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Anasth Intensivther Notfallmed · Aug 1986
[Course of central body temperature in the laminar airflow operating room in various anesthesia procedures].
The oesophageal body temperature of 130 patients was measured pre- and intraoperatively. 92% (n = 116) of the operations (implantation or replacement of hip prostheses) were performed in an operating room having a laminar air flow system with horizontal air flow. 9% (n = 14) of the operations (laparotomies) were performed in a room of identical design without an air circulation system. Three different forms of anesthesia were investigated with regard to their influence on interior body temperature: 1) general anesthesia with a volatile anesthetic (INH); 2) peridural anesthesia with additional general anesthesia (KPDA+ITN); and 3) neuroleptic anesthesia (NLA). A drop in temperature during the operation was found in all patients. ⋯ In the operating room with laminar air flow the INH-patients sustained the greatest decrease in temperature; the mean value in the first hour was 1.1 degrees C/h, and up to 4.6 degrees C/3 h toward the end of the operation. There was a comparable drop in temperature in the first hour in patients anesthetized with KPDA+ITN, but the rate slowed down toward the end of the investigation (2.2 degrees C/3 h). NLA caused a characteristic temperature behavior, with an initial fall in temperature, plateau phase, and subsequent rise (total: -1.0 degrees C/3 h) Temperature regulation was influenced least by NLA in the operating room with laminar air flow; thus, in this context, NLA proved to be a favourable form of anesthesia.