Sepsis is a generalized, usually infectious disease with a complex dsyregulated immune response and capillary leak. The leakage leads to a severe drop of blood pressure with hypoperfusion and ...sympathetic counterregulation. The lung is frequently involved either as a source of the inflammation or by emergence of an ARDS, both resulting into severe hypoxemia. The supportive therapy is used to stabilize the hemodynamics and to keep the target value partial pressure of arterial oxygen (PaO2) in the lower limit of normal. Pathophysiologically it is not plausible to define hypoxemia on the basis of PaO2 or SaO2, because the supply of the cells is determined by the amount of oxygen molecules. This is mirrored by the oxygen content (CaO2) and the hemodynamic transport, the cardiac output. As far as data about the hypoxic tolerance of organs are available, the critical value respective the threshold for anaerobic metabolism is 5-10 folds lower than values achieved by application of current guidelines. If CaO2 would be used as the target value, a lot of measures aiming for normoxia, which potentially harm patients, could be avoided. Among these measures are high, often toxic inspiratory concentrations of oxygen, high ventilation pressure, dangerous body position changes and excessive volume administration. It is not surprising, that there are no plausible data in the literature which have shown a positive effect for the target value PaO2 or SaO2. Studies are urgent needed to compare CaO2 as a target value to the standards in the current guidelines. Additional animal experiments should be done to get information on the critical range of CaO2, in order to translate these results into treatment strategies for intensive care unit patients with severe hypoxemia.
Spirometry plays the major role in pulmonary diagnostics in the family practice, but is still used much too rarely on patients with respiratory symptoms. Every patient with shortness of breath or a ...chronic, persistent cough should have spirometry performed. Needless to say, taking a selective medical history and auscultation of the lungs and heart are additional, important pillars for making a diagnosis. Measurement of the peak expiratory flow (PEF) can be especially helpful in emergencies. Pulse oxymetry also aids in the assessment of acute situations and additionally, can provide valuable information in the follow-up treatment of chronic respiratory diseases.
This study was aimed at assessing health-related quality of life (HRQL) in patients with chronic respiratory failure (CRF) and long-term survival following prolonged intensive care mechanical ...ventilation.
Observational cohort study.
Patients with CRF who had been transferred to our specialized weaning centre due to prolonged mechanical ventilation (>14 days) and weaning failure.
Out of 87 long-term survivors (>6 months), 73 patients (mean age: 60.3±13.6 years, chronic obstructive pulmonary disease (COPD, 43%), thoraco-restrictive (21%) or neuromuscular disorders (15%), various chronic diseases (22%)) returned the MOS 36-Item Short-Form Health Status Survey (SF-36) and the St. George's respiratory questionnaire (SGRQ).
The total ventilation time was 38.7±45.9 days. The time between discharge from ICU and HRQL assessment was 31.0±22.2 months. Physical health was markedly reduced compared to general population norm, but mental health was mildly impaired. HRQL was comparable to patients with stable CRF receiving non-invasive ventilation who did not need prolonged invasive MV. In addition, general HRQL was better in patients with restrictive respiratory disease compared to patients with neuromuscular diseases (
P
<
0.0
5
). Physiological parameters such as blood gases or lung function parameters were not correlated to any HRQL measurements.
In patients with CRF surviving prolonged ventilation on ICU, the presence of CRF itself is the major determinant of HRQL. Here, the underlying cause of CRF is the major factor which determines the degree of HRQL impairment with patients suffering from restrictive ventilatory disorders reporting the best HRQL when compared to patients with COPD or neuromuscular diseases. Despite severe physical handicaps due to CRF mental health is only mildly compromised.
SCHULZ, H. - J.: Interessante Stechimmen (Hymenoptera, Aculeata) des Nationalparkes "Unteres Odertal", insbesondere aus dem Criewener Teil ;SIEGMUND, R.: Chronobiologie und Verhalten bei Fischen ...(Pisces, Cyprinidae) ; WUNTKE, B.; LUDWIG, I.: Zur Nahrungswahl der Schleiereule (Tyto alba guttata) im Landkreis Potsdam-Mittelmark (Brandenburg) ; GEBAUER, A.; KAISER, M.: Anmerkungen zur Lautentwicklung und zum Stimmbruch beim Grauen Kranich (Grus grus) ; ROBEL, D.: Revier und Revierverhalten bei der Blauracke (Coracias garrulus) ; KNEIS, P.: Vorkommen und Schutz der Saatkrähe (Corvus frugilegus) im nordsächsischen Elbe-Röder-Gebiet um Riesa-Großenhain ; WALLSCHLÄGER, D.: Was ist ein Goldammerdialekt? ; SCHEIBE, K.M.; LANGE, B.; SIELING, Ch.; SCHEIBE, A.; HEINZ, C.; GLADITZ, F.: Entwicklung von Ortspräferenzen bei Przewalskipferden und Heckrindern und ihr Einfluß auf Vegetationsstrukturen ;MENDE, W.; WERMKE, K.: Betrachtungen zur Rolle von Frequenzmodulationen in der sozialen Kommunikation bei Tier und Mensch ; WIPPER, R.: Ethologie und Umweltbildung ; KÖHLER, D.: Zur Lautgebung einiger paläarktischer Soriciden: Analyse von Abwehr- und Positionsrufen
For most dry powder inhalers (DPIs) a defined minimal inspiratory flow must be achieved immediately after the start of the inspiration procedure, to avoid insufficient deposition in the lung and ...excessive drug deposition in the patient's mouth and/or oropharynx. The Novolizer
® (VIATRIS GmbH & Co. KG, Frankfurt, Germany) provides a combination of technical features that ensure that every inhalation manoeuvre is performed with adequate inspiratory and sufficient drug particles are delivered to the patient's lung. One of these technical features is an inspiratory flow rate threshold triggering feedback mechanisms to the patient which confirm that an adequate inspiratory flow rate (minimum 35–50
l/min) has been achieved. Correct inhalation manoeuvre is confirmed to the patient by optical, acoustic and taste feedback which is likely to improve patient compliance. The Novolizer
® also delivers a high-quality aerosol (high fine particle fraction representing the proportion of respirable particles), provides a refillable cartridge system, an accurate dose counter, a low intrinsic resistance, and enables reliable and consistent dose delivery. The Novolizer
® is at the cutting edge of inhalation technology and represents a major step forward in DPI design.
Abstract There is no published data about mask features that impact skin contact pressure during mask ventilation. To investigate the physical factors of skin contact pressure formation. We measured ...masks with original and reduced air cushion size and recorded contact pressure. We determined cushion contact and mask areas by planimetric measurements. Contact pressures necessary to prevent air leakage during inspiration exceed inspiratory pressure by 1.01±0.41 hPa independent of cushion size. Contact area, ventilator pressure and mask area during inspiration and expiration impact contact pressure. Mask contact pressures are higher during expiration. The contact pressure increases with increase in inspiratory pressures independent of the ventilator cycle. During expiration, the contact pressure will increase in proportion to the expiratory pressure reduction of the ventilator. The mask with reduced air cushion size developed higher contact pressures. Contact pressure can be reduced by selecting masks with a small mask area in combination with a large mask cushion.
To compare the Therapeutic Intervention Scoring System (TISS) 28 in difficult to wean patients before and after transfer to a weaning center.
Using TISS-28, the authors investigated the difference ...between regular intensive care units (ICUs) and the respiratory ICU (RICU) of their hospital in difficult to wean patients after long-term mechanical ventilation (MV). Special emphasis was placed on the appropriateness of TISS-28 to cover the specific weaning activities. 63 tracheotomized patients ventilated for more than 14 days were included.
In total, 15.9% of patients were not weaned, 20.6% of population was successfully weaned with noninvasive ventilation (NIV), and 63.5% of patients was successfully weaned without NIV. The transfer of patients from other ICUs to a weaning facility resulted in a significant reduction of total TISS-28 from 29.5 to 23.8 points (p<0.001) on average.
The high weaning success rate in a specialized facility is associated with a significant reduction of TISS-28 scores. The use of TISS-28 in a weaning center for patients with prolonged MV to measure workload does not adequately mirror the efforts by physicians, nurses, physiotherapists, and other health-care personnel.
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