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Biomedical subjects

C Mebius

Publications and source records attributed to C Mebius.

16 recordsLinked to original sources
PubMed2000

Management of minor head injuries in emergency departments in Sweden. Time for a new strategy?

OBJECTIVE: To study how patients with minor head injuries are currently managed. DESIGN: Questionnaire to senior residents in emergency departments and data from registers covering all in-hospital care in Sweden. SETTING: All 92 emergency departments in Sweden. RESULTS: The response rate to the questionnaire was 100%. In Sweden, 75 emergency departments treat patients with minor head injuries. Four departments are paediatric. General surgeons are the main providers (87%) of care for patients with minor head injuries. All hospitals admit patients with a history of unconsciousness or amnesia. Skull radiography is not used routinely. The estimated use of computed tomography (CT) varies between 2% and 80%, the mean being 22%. The need for CT, or the result thereof, is not the deciding factor for admission. In 1996, 16877 patients were treated as inpatients for minor head injuries, (191/100000 inhabitants). The admission rates varied widely among departments, and the total figures have been constant since 1987. The mean hospital stay was 1.6 days, so a large number of hospital days are consumed. The resources more than cover routine CT investigations for those seeking care, and hospital care for those with abnormal findings or special needs. CONCLUSION: In Sweden, patients with minor head injuries are routinely admitted to hospital for observation. The estimated use of CT varies considerably. No clinics report using CT to triage patients for admission, a strategy that would be consistent with effectiveness and economic arguments.

Adolescent↗
PubMed1999

Public disclosure of health care performance reports: comments and reflections from Sweden.

In all countries quality improvement is a very important issue. At the same time the demands for information from consumers are increasing. By combining these two principles we can gain a great deal. In my opinion we will go both ways. Bad results, if publicly disclosed, are probably the strongest incentive to improve if they are reliable. Confidential performance feedback for self improvement is the way Sweden is heading at the moment. In the near future, I am sure, we will publish performance reports accompanied by analytic comments regarding quality indicators that are well defined and easy for consumers to evaluate. A pre-condition is that the medical profession must have time to get accustomed. Only experience will show how to devise the most effective means to improve quality and confidence in health care. We will follow the progress in the USA with great interest.

Consumer Advocacy↗
PubMed1994

A new colorimetric breath indicator (Colibri). A comparison of the performance of two carbon dioxide indicators.

Colorimetric carbon dioxide indicators are designed for the verification of satisfactory tracheal tube placement. However, widespread use of the device in this and other applications is hampered by limitations in its performance characteristics. A new colorimetric breath indicator (Colibri) has been developed that overcomes major shortcomings of current technology. A simple method is described that can be used to evaluate the properties of colorimetric carbon dioxide indicators in a quantitative way.

Breath Tests↗
PubMed1992

Heat and moisture exchangers with bacterial filters: a laboratory evaluation.

Six commercially available heat-moisture exchanger (HME) humidifiers with built-in bacterial filtration were evaluated by laboratory tests. Physical characteristics, humidification efficiency, resistance to flow and filtration capability were investigated. The resistance was comparable for all units and did not change notably with exposure to humidity. Deadspace values were in the range 55-92 ml and weight values between 34-55 g. The humidification efficiency of two units (Group 1) was clearly less (54%-63% at 11 tidal volume), than for the other four devices (Group 2) (77%-82%). This corresponds to an average humidification output of 22.0 g/m3 for Group 1 as compared to an output of 29.9 g/m3 for Group 2. The average filtration capability of Group 1 was 99.9998%, which is somewhat higher than the 99.9973% obtained for Group 2. There are significant differences between the humidification efficiency and deadspace of different units, with the Pall Conserve device having the least satisfactory performance. All units exhibit good filtering properties, with the Pall Conserve device performing best in this respect.

Anesthesiology↗
PubMed1987

Neonatal hygroscopic condenser humidifier.

A hygroscopic condenser humidifier was developed for neonates on mechanical ventilation and was evaluated by laboratory tests and clinically. Humidification provided by the unit was measured in the 10- to 50-ml tidal-volume range at ambient temperatures of 24 degrees C and 38 degrees C. The effect of a leaking patient connection on device performance was investigated. Leakage rates were measured routinely in a neonatal ICU and surgery to determine the clinical significance. In the entire tidal volume and temperature range, the unit provided an inspiratory water content in excess of 30 g/m3 when the leak fraction (volume leaked/volume delivered at Y-piece) was less than 15%. This was found in three out of four cases. In about one out of ten cases, the leak exceeded 30%, which invariably led to corrective action, such as repositioning or changing the endotracheal tube. However, even at a 30% leak, a water content of about 26 g/m3 was still available for humidifying the inspired gas, which corresponds to normal physiologic conditions found in the trachea for nasal breathing of room air.

Humans↗
PubMed1983

Fat emulsion as a vehicle for diazepam. A study of 9492 patients.

Conventional preparations of diazepam for i.v. use contain solvents which cause pain on injection and thrombophlebitis in a high percentage of cases. However, diazepam can be dissolved with advantage in the oleaginous phase of an oil-in-water emulsion (Diazemuls). Diazemuls has been given to 9492 patients without serious side-effects. Following i.v. injection, 2435 patients were studied with respect to pain and clinical effect. Only 0.4% experienced pain. The intended clinical effect was recorded in 99% of the patients. I.m. injection of Diazemuls resulted in a significantly smaller frequency of pain in connection with the injection than did the injection of Valium (7% and 43% respectively). Pharmacokinetic studies have been made after i.v. and i.m. injection of Diazemuls and Valium. The distribution and elimination phases after i.v. injection were the same with both forms. Thus the drug probably quickly separates from the oil particles of the emulsion after injection. After i.m. administration, the plasma concentration shows a wide spread with both preparations. A brief survey of other substances tested in emulsion form is presented.

Adolescent↗
PubMed1983

Ventilation - perfusion relationship during hip arthroplasty.

Ventilation-perfusion relationships (VA/Q) were studied during hip arthroplasty, using a multiple inert-gas elimination technique. True shunt (VA/Q = O) increased on 10 out of 16 prosthesis-anchoring occasions, while "low" VA/Q values (O less than VA/Q less than 0.1) increased on 2 occasions only. Pao2 fell by 1-2 kPa. "High" VA/Q values (10 less than VA/Q less than 100) appeared or increased with the insertion of the prosthesis, while dead space (VA/Q greater than 100) was unaltered. Cardiac output did not change. Pulmonary artery pressure fell and airway peak pressure rose by approximately 2 mmHg. It is possible that the blood flow is forced from non-dependent to dependent lung regions by the altered pressure in airways and blood vessels, creating a "high" VA/Q in upper and shunt regions and a "low" VA/Q in lower lung regions.

Aged↗
PubMed1983

A comparative evaluation of disposable humidifiers.

The performance of four hygroscopic condenser humidifiers (HCH) and two conventional heat and moisture exchangers (HME), all commercially available, have been evaluated in laboratory tests. A clinical study was also made in order to confirm the test results. It was found that the new generation of heat and moisture exchangers, which have hygroscopic properties, are superior to conventional HME units. When dry inspired gases are used, the HCH units, but not the HME units, deliver a moisture level that is comparable to what is produced in the upper trachea during normal breathing the nose. Our clinical experience as well as the extensive body of literature on humidification requirements support the conclusion that in most cases they can be recommended to be used for extended time periods even with dry gases. The humidification efficiency decreases with increasing tidal volume for all units. However, the best units can be used up to tidal volumes of 1000-1500 ml. The dead space of these units varies from 90 ml to 100 ml and the resistances are only about 50 Pa at 0.5 l/s. The weight is in the range 18-40 g. One of the best HCH devices also has distinct antimicrobial properties. The others are found at least not to promote organism growth. This feature added to others such as safety and simplicity in use make an HCH device an attractive alternative to conventional humidification techniques.

Humans↗
PubMed1982

Gas exchange and respiratory mechanics during hip arthroplasty.

Gas exchange and respiratory mechanics were studied during hip arthroplasty, according to Charnley (1961). Dead space measurements were made by capnography and thoracic compliance and resistance, calculated from tracheal pressure variations and respiratory gas flow. PaO2 fell by 2.5 kPa with the insertion of each prosthesis. Small increases in PaCO2 were also seen. Distal (approximately corresponding to alveolar) dead space increased by 25% when each prosthesis was anchored. Dynamic thoracic compliance fell by 30-40 ml/kPa at the insertion of either prosthesis, while inspiratory and expiratory resistance were unaffected. The findings may indicate interference with the functions of both the bronchial and the pulmonary vascular tree.

Adult↗
PubMed1982

Airway closure and distribution during hip arthroplasty.

Airway closure, resting lung volume (FRC) and gas distribution were assessed single breath nitrogen washout during hip arthroplasty. Airway closure occurred above FRC in all the patients during enflurane anaesthesia and surgery, with no change in either FRC or airway closure when the femoral and acetabular prostheses were inserted. The slope of the nitrogen alveolar plateau, which was considered to indicate gas distribution, rose significantly from 4.1 to 5.7% N2/1 when the prostheses were inserted. By the end of surgery the slope had returned to the initial value. This finding indicates a transient effect on the airways when the prostheses are implanted.

Adult↗
PubMed1982

Deep vein thrombosis following hip surgery. Relation to activated factor X inhibitor activity: effect of heparin and dextran.

Activated factor X inhibitor (FXaI) activity was measured with a newly developed method during operation and during the postoperative period in 60 patients undergoing total hip replacement. The patients were randomly allotted to three groups. In two groups the effect of prophylactic treatment with dextran and low dose heparin were evaluated, while the third group served as a control. Postoperative deep vein thrombosis was diagnosed with plethysmography and venography and related to observed changes in inhibitor activity. The frequency of deep vein thrombosis was found to be 25, 47 and 33 per cent in the three groups respectively. With the test system for measurements of FXaI-activity which made it possible to determine both the overall ability of the plasma to neutralize FXa and the activity independent of any accelerator or antagonist of XaI-activity, it was possible to demonstrate inhibitor consumption in all groups including the heparin treated group where the overall inhibitor activity was increased. A marked decrease in inhibitor activity was usually observed in the patients developing postoperative thrombosis in the control group, while in the other groups the relationship was less clear.

Aged↗
PubMed1976

Diazepam in emulsion form for intravenous usage.

Since aqueous solutions of diazepam were introduced into clinical practice, the problem has arisen of local vascular side effects after intravenous injection. A new preparation of diazepam as a lipid emulsion is presented. It was prepared by Vitrum and shows many similarities to Intralipid. A clinical trial was designed to study the incidence of pain in connection with the intravenous injection of diazepam and the incidence of subsequent thrombophlebitis. The preparation was used as a sedative to patients before gastroscopic investigation and as an inductor to general anaesthesia. In the material of 88 patients, thrombophlebitis was observed in 1.1%. Only 1 patient in the group of 314 patients studied complained of pain in connection with injection. The results observed were compared with previous investigations from the literature and with parallel control investigations. The new lipid emulsion form of the preparation was found to reduce significantly the incidence of local side effects involving the venous system. No significant difference in the therapeutic effect of the different preparative forms of the active substance was observed. The possible mechanisms involving the production of thrombophelbitis in connection with the injection of aqueous solutions of diazepam are discussed.

Adjuvants, Anesthesia↗
PubMedDate not supplied

The Hygroscopic Condenser Humidifier. A new device for general use in anaesthesia and intensive care.

The design and performance of the Hygroscopic Condenser Humidifier (HCH) are described. In principle the HCH consists of two parts, a conventional Heat-Moisture-Exchanger (HME) and a hygroscopic unit. The hygroscopic action is shown to improve the water retention efficiency of the device by about a factor of two as compared with optimal HME designs. As a result, humidification levels corresponding to around 80% relative humidity at 37 degrees C are obtained in the trachea and this is also achieved when completely dry gases are delivered to the patient. The unit can therefore be used for all procedures in anaesthesia and in intensive care.

Adult↗
PubMedDate not supplied

Differential ventilation in acute respiratory failure. Indications and outcome.

Acute respiratory failure (ARF) is a life-threatening condition which frequently requires ventilatory support. Many patients die of hypoxaemia despite a high inspired oxygen concentration and application of general positive end-expiratory pressure (PEEP). Differential ventilation has been used in selected patients with unilateral lung disease or with large inequalities in pathology between the two lungs. An important contributor to the hypoxaemia is a vertical inequality in the ventilation-perfusion (V/Q) matching. This can be compensated for by placing the patient in the lateral position, ventilating each lung separately in proportion to its assumed blood flow, and applying PEEP selectively to the dependent lung to counteract airway closure and alveolar collapse and thus improve the gas distribution within that lung. This ventilatory regime should promote V/Q matching better than general PEEP, and will not impede cardiac output. Major improvement in gas exchange has been achieved in short-term experiments and in prolonged ventilator treatment of patients with ARF.

Acute Disease↗