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Biomedical subjects

C P Criée

Publications and source records attributed to C P Criée.

At least 19 recordsLinked to original sources
PubMed2006

[Quality of life in patients with home mechanical ventilation].

Health-related quality of life (HRQL) is defined as a psychological construct describing the subjectively experienced health status based on different components of health including physical state, psychological well-being, social relations and functional capacities. Assessment of HRQL has become steadily more essential in order to evaluate the costs and benefits of modern treatment modalities in patients with chronic and incurable diseases. This is particularly true for patients with home mechanical ventilation (HMV) and severe objective limitations in daily living. Modern instruments such as the Severe Respiratory Insufficiency (SRI) Questionnaire have been specifically designed for clinical trials which aim at assessing the effects of HMV on HRQL in these patients. Recent work has shown that mental health in clinically stable patients following establishment of HMV can be normal despite substantial physical handicaps. Further, HRQL has been shown to be predominantly influenced by the underlying disease. Accordingly, there is increasing evidence that HMV provides beneficial effects on HRQL in patients with neuromuscular and thoracic rib cage diseases, but in contrast, this remains still controversial in patients with COPD. Here, prospective controlled trials using modern specific instruments for HRQL assessment are required in the future to reliably evaluate the effects of HMV on HRQL in patients with COPD.

Anxiety↗
PubMed2004

[Multicenter study on "non-invasive ventilation in patients with severe chronic obstructive pulmonary disease and emphysema(COPD)"].

Non-invasive ventilation is applied with increasing frequency in patients with chronic hypercapnic COPD and insufficiency of the ventilatory pump. In the few existing clinical trials on long-term use of NIV, no significant improvement on survival could be proven, mainly due to methodical reasons. The "National Task Force for Non-invasive ventilation and weaning" plans to study patients with severe COPD and hypercapnic ventilatory pump insufficiency in a prospective, randomised, multicentre clinical trial over one year. In the intervention group, NIV will be applied for at least six hours per day in addition to standard COPD-treatment. The target of mechanical ventilation is a reduction of PCO (2) during spontaneous breathing by at least 20 %, or into the normal range. The main outcome parameter is all-cause mortality, secondary outcome parameters are course of the disease, exercise capacity, quality of life and consumption of medical resources. The sample size is estimated on 300 patients (150 control group, 150 intervention group). The whole study will take approximately three years.

Emphysema↗
PubMed2004

Peak or plateau maximal inspiratory mouth pressure: which is best?

There is no clear evidence as to how maximal inspiratory mouth pressure (PI,max) should be measured, although plateau pressures sustained for 1 s and measured at residual volume (RV) are usually recommended. Peak and plateau PI,max were measured at RV and at functional residual capacity (FRC) in 533 healthy subjects (aged 10-90 yrs) in order to comparably test all PI,max measurements for their predictors, reproducibility and normal values. Plateau pressures accounted for 82.0-86.3%, of peak pressures. Peak and plateau pressures measured at FRC accounted for 84.3-90.5% of pressures at RV, and were highly correlated. Age was negatively predictive and weight and body mass index positively predictive of PI,max, but regression parameters were low. All PI,max measurements were comparable when calculating regression parameters, between-subject variability and reproducibility. In conclusion, peak and plateau maximal inspiratory mouth pressure are comparably useful for the assessment of inspiratory muscle strength and can be reliably measured at functional residual capacity and at residual volume. Regression equations are of low impact in predicting normal values due to the weak influence of demographic and anthropometric factors and to the high unexplained between-subject-variability. Age-related 5th percentiles can indicate the lower limit of the normal range.

Adolescent↗
PubMed2001

Marked sympathetic activation in patients with chronic respiratory failure.

The autonomic nervous system may be disturbed in chronic respiratory failure. We tested the hypothesis that there is increased sympathetic activity in patients with chronic hypoxemia. Furthermore, we examined the effect of short-term oxygen on muscle sympathetic nerve activity (MSNA) in these patients. We performed microneurography of the peroneal nerve in 11 patients with hypoxemia due to chronic obstructive pulmonary disease (COPD, n = 6) or lung fibrosis (n = 5) and in 11 healthy subjects matched for age and sex. MSNA was measured during normal breathing in all subjects. In eight patients and in seven control subjects, MSNA was also measured during nasal oxygen (4 L/min). MSNA was higher in the patients with chronic respiratory failure compared with the healthy subjects during normal breathing (61 +/- 5 versus 34 +/- 2 bursts/min, mean +/- SEM; p = 0.0002, paired t test). During oxygen administration, MSNA decreased from 63 +/- 6 to 56 +/- 6 bursts/min in the patients (p = 0.0004, ANOVA); there was no change in sympathetic activity in the control subjects. For the first time, there is direct evidence of marked sympathetic activation in patients with chronic respiratory failure. This is partly explained by arterial chemoreflex activation and may play an important role in the pathogenesis of the disease.

Adult↗
PubMed2000

Pulmonary arteriovenous fistula drainage into the left atrium.

Arteriovenous fistulas with venous drainage into the left atrium are a rare anomaly. Although the etiology of pulmonary arteriovenous fistulas is unknown, these abnormalities are considered to have occurred during early fetal development. A case of this malformation in a 72-year-old woman successfully treated by surgery is described.

Aged↗
PubMed1999

[Endotracheal complications after long-term ventilation. Noninvasive ventilation in chronic thoracic diseases as an alternative to tracheostomy].

PATIENTS AND METHODS: In this present retrospective study we examined 62 long-term ventilated patients, whose weaning from respirator failed, for endoscopic airway complications and the frequency of consecutive surgery required. Furthermore noninvasive volume-controlled intermittent ventilation was evaluated as an alternative method to tracheostomy for maintaining mechanical ventilation and weaning of patients with chest wall disorders, neuromuscular and chronic obstructive lung disease. RESULTS: 25 patients with endotracheal tube and 37 with tracheostomy who had been long-term ventilated in different intensive care units for 18 +/- 12 respectively 57 +/- 27 days (19 +/- 12 days via endotracheal tube) could be weaned successfully consequently using a volume-controlled intermittent ventilation via an individually adapted face mask. We found 2 patients of the group with endotracheal intubation (median age 59 +/- 15 years, 11 female, 14 male, median duration of mechanical ventilation via tube 18 +/- 12 days) to have visible injuries of the respiratory tract without consecutive surgery being necessary. All of them were successfully weaned from respirator via noninvasive ventilation (in 2 of them completely spontaneous breathing was re-established, 23 patients needed intermittent ventilation at home). Of the 37 patients with tracheostomy (median age 59 +/- 15 years, 15 female, 22 male, median duration of mechanical ventilation 57 +/- 27 days, tracheostomy on day 19 +/- 12) 19 cases (51%) showed endoscopically visible injuries of the respiratory tract of whom 7 cases (19%) were severe and made consecutive surgery necessary. 29 patients were discharged with noninvasive ventilation at home, 5 needed further invasive ventilation via tracheostomy and 3 patients breathed spontaneously without ventilatory support. The incidence of severe tracheal stenosis following long-term ventilation via tracheostomy was nearly 20% (1 tracheoesophageal fistula) and needed surgical treatment. CONCLUSION: As even duration of ventilation via tracheal tube and mode of ventilation before transfer to our clinic was comparable in both groups noninvasive ventilation is an appropriate alternative to tracheostomy following endotracheal intubation for maintaining ventilatory support, especially for patients with chronic ventilatory insufficiency.

Chronic Disease↗
PubMed1999

[Nasal mechanical ventilation in children].

BACKGROUND: Nasal mechanical ventilation is not only applicable to adults but also in childhood when necessary. PATIENTS AND METHODS: Thirty-six children suffering from various neuromuscular diseases were brought up by their parents to learn nasal mechanical ventilation. Thirty children had to be ventilated, because of symptomatic ventilatory failure, reduced ventilatory muscle capacity or hypercapnia. RESULTS: Thirty-five children could be adapted to nasal mechanical ventilation, 1 girl needed a naso-oral mask. All children wanted to continue with ventilation because they realized the benefit. Their symptoms disappeared. CONCLUSIONS: The management of ventilatory failure should be the same in adults and children. Nasal mechanical ventilation is indeed a good possibility for children even in early childhood. Children should be introduced to mechanical ventilation at the beginning of the symptoms of ventilatory failure.

Adolescent↗
PubMed1999

[Amyotrophic lateral sclerosis and nasal mechanical ventilation].

BACKGROUND: Patients suffering from amyotrophic lateral sclerosis (ALS) can profit from nasal mechanical ventilation and improve in the quality of life. PATIENTS AND METHODS: Thirty-eight patients were introduced to nasal mechanical ventilation, using pressure- and volume-cycled respirators. The daily periods of mechanical ventilation varied from 8 to 24 hours. RESULTS: Twelve women and 26 men with ALS mostly with severe symptoms were adapted to the intermittent nasal ventilation. 80% had bulbar symptoms. Nineteen patients died till now. Even when complications occurred it was possible to use the noninvasive ventilation. CONCLUSIONS: Noninvasive mechanical ventilation is possible in spite of complications and improves the quality of life in ALS.

Adult↗
PubMed1999

[Fitness training during nasal ventilation in diseases limited by dyspnea].

METHODS: Five patients with chronic ventilatory failure demonstrated by arterial hyperkapnia and overloaded respiratory muscles under spontaneous ventilation (P01/P01 max) were adapted to passive noninvasive ventilation (ISB). Three of them suffered from severe COPD (FEV1 < 50%), two patients from severe restriction (VC < 30%). These patients had to undergo a bicycle ergometer exercise with and without nasal ventilation until they reached physical exhaustion with standardised incremental increase in external workload. RESULTS: In both settings all patients were able to manage exercise up to their physical exhaustion. The anaerobic limit was exceeded each time. The total ventilation volume had to be increased two- to threefold during exercise with nasal ventilation to maintain the passive ventilation. The reduced load on the respiratory muscles was generally proven by lower pCO2 and higher pH levels. Without ventilation discontinuation of the exercise was caused by dyspnoea, whereas this was due to weakness in the legs under ventilation. In all five cases the achieved level of external workload was higher when supporting the respiratory muscles (43 watts vs. 36 watts) at lower lactate levels. CONCLUSION: On a bicycle ergometer the respiratory muscles can be sufficiently relieved using noninvasive nasal ventilation. A higher level of workload, longer duration and a higher quality of exercise can be achieved thereby. The fact that patients without relief of load of the respiratory muscles complained of dyspnoea, whereas the fact that patients with ventilation complained of weakness in their legs indicates the high efficiency of this method, although the tested patients are severely handicapped individuals who usually do not undergo comparable physical exercise in their daily activities.

Aged↗
PubMed1998

Induction combination chemotherapy with docetaxel and carboplatin in advanced non-small-cell lung cancer.

BACKGROUND: Results in the therapy of locally advanced non-small-cell lung cancer (NSCLC) by operation and/or irradiation only are poor. To improve the long-term prognosis a systemic induction chemotherapy may be successful in reducing local tumor burden and eliminating micrometastases. The efficacy of preoperative docetaxel-carboplatin combination chemotherapy was studied in a phase-II study for NSCLC stage IIIB. METHODS: 15 patients with functionally operable stage IIIB NSCLC (10 squamous-cell, 4 adeno, 1 large-cell) were enrolled to receive 4 cycles of docetaxel (100 mg/m2, day 1) and carboplatin (AUC 7.5, day 2) on an outpatient basis with G-CSF support after cycle 1 and were subsequently evaluated for surgery. Postoperatively the patients were irradiated with 50 Gy (R0-resection) or 60 Gy (R1-resection). RESULTS: Acceptable hematologic and non-hematologic toxicity was observed. On an intent-to-treat basis, 14 patients were evaluable for radiological response after 4 cycles of chemotherapy (1 patient still on therapy): 11/14 patients had radiological response of > or = 50%, 1/14 progressive disease, 2 exclusions because of toxic death (1 patient) and capillary leak (1 patient). Of 11 patients evaluated for surgery, 9 patients were resected, 1 patient is awaiting operation, 1 patient received radiotherapy because of an esophageal fistula. By histological findings a downstaging was achieved in 6/9 resected patients: histological complete response (CR) in 4 patients, partial response (PR) in 2, and no response in 3. With a mean follow-up of 8.1 months (excluding 1 patient in early postop course), 5/5 R0 and histological responders are alive and disease-free. Of the 3 histological non-responders, 1 patient (R1/2 resection) died of respiratory failure, 2 patients (1 R1 and 1 R0) of distant metastases. CONCLUSION: Outpatient therapy with docetaxel/carboplatin chemotherapy is effective in downstaging patients with NSCLC, toxicity is acceptable. Histological response may be the most important prognostic factor. The early results of this phase II study encourage evaluation of the long-term benefit within a prospective randomized phase III study.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[Epidemiology and diagnosis of intermittent self-ventilation].

The purpose of the lung is intrapulmonary gas exchange. The circulatory system delivers the respiratory gases to the tissue. The ventilatory pump however is responsible for the circulation of air between the lungs and the ambient atmosphere. Due to better diffusing capabilities, hypercapnia always is a result of pump failure and little dependent on the lung. Ventilatory failure, either compensated with an increased demand on the muscles or decompensated with an additional increase in pCO2, should be separated from lung failure where primarily oxygen exchange is involved. Decompensated hypercapnic ventilatory failure is then the indication for intermittent mechanical ventilation. The pCO2, either arterial or transcutaneously registered together with the noninvasive evaluation of the mouth occlusion pressures during tidal breathing and during a maximal inspiratory effort, define well the severity of ventilatory failure. In acute on chronic ventilatory failure, noninvasive mechanical ventilation in three randomised and controlled studies resulted in a better survival compared to intubation. To fulfil certain weaning criteria is no longer required in difficult to wean patients, as a transfer from invasive to noninvasive mechanical ventilation can be performed if only cooperativity is preserved together with a minimal capacity of spontaneous breathing. Weaning will thereafter occur by progressive relief from intermittent noninvasive ventilation. 2300 difficult to wean patients in Germany should profit from this approach. Chronic ventilatory failure as a result of neuromuscular disease or scoliosis of the thoracic spine are the classical indications. COPD and myasthenia gravis are under discussion as indications for intermittent mechanical ventilation with an increasing tendency to ventilate. Epidemiological data however can only be roughly estimated due to the heterogeneity of indication and selection of the patients.

Cross-Cultural Comparison↗
PubMed1997

[The etiology of chronic hypercapnia].

BACKGROUND: The ventilatory and the pressure response to CO2 in patients with advanced thoracic disorders are critically dependent on the mechanics of the lung and the respiratory muscles. Changes in drive, therefore, can not be directly assessed with that method. However during changes as a result of intermittent mechanical ventilation, changes in drive can be assessed, if lung and muscle mechanics remain unaffected. In addition, to study changes in ventilatory drive independently in patients successfully treated by intermittent mechanical ventilation, we determined the recruitment threshold, pCO2RT, of the unloaded ventilatory pump to CO2. PATIENTS: 16 patients with various disorders (4 COPD, 4 COPD and sleep apnoea, 7 scoliosis, 1 fibrothorax) were studied, 14 during nasal IPPV and 2 during mechanical ventilation via tracheostomy. RESULTS: After they had been successfully adapted to the ventilator, they were entered into the study. The apnoea threshold in all cases had already been reached during the adaptation period. pCO2AT was determined 32 +/- 5 mm Hg. While the patients were passively ventilated, the inspiratory CO2 was increased every 5 minutes, resulting in a stepwise increase in arterial pCO2 by 3 mm Hg. The recruitment threshold pCO2RT was then defined as the lowest pCO2, which resulted in a deformation of the inspiratory pressure curve by the patients own inspiratory efforts. pCO2RT was reproducible within trials and in different trials with a standard error of 1.2 mm Hg. It was found 6 +/- 4 mm Hg above the pCO2 during spontaneous breathing (p < 0.01) in all patients. pCO2RT decreased from 58 +/- 10 to 47 +/- 4 mm Hg during intermittent IPPV and so did the threshold during CO2 rebreathing, while spontaneous pCO2 decreased from 53 +/- 12 to 42 +/- 5 mm Hg. The slope, reflecting drive was decreased to 0.28 compared to normals but remained unchanged 0.32 (n. s.) during the study. Lung function did not change. A highly significant increase in the indices of maximal inspiratory force was observed (p < 0.002) and as a result a decrease in the inspiratory demand (p < 0.008). CONCLUSION: Intermittent IPPV does efficiently suppress phasic respiratory drive via thoracic afferent inhibition and therefore effectively unloads the ventilatory pump. The CO2 threshold is increased in patients with hypercapnic ventilatory failure, probably to minimise the load to the ventilatory muscles. With the increase in inspiratory capacity the pCO2 threshold can be restored to normal by intermittent noninvasive or invasive IPPV.

Adult↗
PubMed1997

[Quality of life in home ventilation].

BACKGROUND: The purpose of this study is to assess quality of life in patients with chronic respiratory failure who require home mechanical ventilation (HMV). PATIENTS AND METHODS: Patients with COPD (n = 20), scoliosis (n = 20), neuromuscular diseases (n = 20) and others (n = 7) were examined. A specific questionnaire containing forms for the patient, the physician and for the relatives was developed according to the formulation of the question (Fragebogen zur chronischen Heimbeatmung = FCH, Interview zur chronischen Heimbeatmung = ICH). In addition to that the Hospital Anxiety and Depression Scale (HAD) and the Asthma Quality of Life Questionnaire were used. Arterial blood gas tensions, pulmonary function and inspiratory mouth occlusion pressure were studied. RESULTS: Quality of life in patients with scoliosis and neuromuscular diseases is improved during HMV compared to patients with COPD who especially are impaired with regard to psychological and functional conditions. Correlations with physiological parameters and with the compliance could not be observed. CONCLUSION: Despite progression of the disease HMV enhances quality of life in patients with scoliosis and neuromuscular diseases. The outcome in COPD is less evident. Therefore the indication must be considered more critically.

Adult↗