PubMed Health⌕ Search

Biomedical subjects

C Putensen

Publications and source records attributed to C Putensen.

69 records · Page 4Linked to original sources
PubMed1992

Assessment of changes in lung microvascular permeability in posttraumatic acute lung failure after direct and indirect injuries to lungs.

We prospectively studied the variation in sequence of occurrence of lung microvascular permeability (LMVP) increase and clinical onset of posttraumatic acute lung failure (ALF) in the sequential failure of organ systems after direct and indirect lung injury. Acute lung failure developed in 52 of 255 trauma patients. Thirty-seven of these developed ALF after a direct injury to lung tissue and 11 after an indirect injury. Lung microvascular permeability was measured with a gamma camera simultaneously over both lungs using indium 113m-labeled transferrin and technetium 99m-labeled erythrocytes in 24 patients with ALF due to direct lung injury and in 4 with ALF due to indirect injury. A localized increased LMVP was observed initially only in the directly traumatized lung (traumatized/nontraumatized lung: 10.03 +/- 5.08/3.73 +/- 3.33 %/h), but involved the primarily nontraumatized lung within 4 days (traumatized/nontraumatized lung: 9.13 +/- 4.49/10.89 +/- 5.05 %/h). In contrast, in ALF due to indirect lung injury, an increased LMVP over both lungs was observed initially (right/left lung: 11.57 +/- 6.18/12.63 +/- 5.73 %/h) and 4 days later (right/left lung: 12.3 +/- 5.49/11.92 +/- 5.75 %/h). Acute lung failure due to direct lung injury occurred significantly earlier (less than 72 h) (P less than 0.01), whereas onset of indirectly induced ALF was later (greater than 72 h). Sepsis syndrome and multiple organ failure were the major complications once ALF occurred after a direct injury. In contrast, sepsis syndrome and multiple organ failure commonly preceded or paralleled the onset of ALF due to an indirect injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1991

[Values of atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP) in cardioversion].

We investigated atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP) in patients undergoing elective direct current cardioversion (CV group) due to atrial fibrillation (n = 9) or atrial flutter (n = 3). Anesthesia for cardioversion (CV) was induced with propofol 1.5 mg/kg. Conversion was achieved in all patients. Before CV all patients had elevated ANP and cGMP plasma levels. After CV the concentrations of ANP and cGMP decreased significantly within 15 and 30 minutes (p less than 0.01), respectively. Only one patient in the CV group showed increasing ANP and cGMP levels although his heart rate had decreased after CV and his blood pressure remained stable. High concentrations of ANP and cGMP might possibly be a compensatory mechanism of cardiac dysfunction. To study the influence the anesthetic agent on plasma levels of ANP and cGMP, we investigated six patients anesthetized with propofol for high-density radiation (HDR group). The data from this control group showed that propofol did not influence the plasma levels of ANP and cGMP. ANP correlated statistically significantly (p less than 0.05) with cGMP in both groups (r = 0.88 and 0.76 in the HDR and CV groups, respectively). In addition, we found a cGMP release of 149.6 +/- 17.6 per mol ANP in the HDR group, in the CV group the release was 109 +/- 54.2 cGMP per mol ANP. This phenomenon could be due to minor response of target cells to ANP stimulation (receptor down-regulation) in patients with heart disease. In conclusion, ANP and cGMP levels decreased after successful cardioversion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The secretion of human growth hormone stimulated by human growth hormone releasing factor following severe cranio-cerebral trauma.

Patients suffering from severe cranio-cerebral trauma show alterations of the secretory patterns of thyroid stimulating hormone (TSH) and human growth hormone (HGH) which may be of prognostic significance. We studied 10 patients following severe brain injury and prospectively compared a new synthetic human growth hormone releasing factor (HGHRF) test with the thyrotropin releasing hormone (TRH) test. On admission, all patients had a Glasgow Coma Scale score of 3 or 4. All patients had a low T3 syndrome. In the patients who died the TSH response after stimulation with TRH was also absent. In the patients who survived a significant TSH increase was observed (p less than 0.05). In comparison to the patients who died those who survived showed a significant (p less than 0.001) HGH increase after HGHRF stimulation. This test might be useful as an additional tool in establishing early prognosis in patients with severe brain injury.

Adult↗
PubMed1990

Gamma scintigraphic imaging of lung microvascular permeability in adult respiratory distress syndrome.

The sequence of lung microvascular permeability (LMVP) changes in early direct posttraumatic and late indirect pancreatitis-induced adult respiratory distress syndrome (ARDS) was studied and compared with that of a control group, as well as non-ARDS ICU patients. A computerized large field of view gamma camera was used to measure LMVP simultaneously over both lungs by In 113m-labeled transferrin and Tc 99m-labeled erythrocytes. The LMVP index (LMVPI) (%/h) was used to quantify LMVP in the dynamic scintigraphic measurement. In the control group the LMVPI was 2.6 +/- 2.8%/h for the right and 2.0 +/- 2.8%/h for the left lung. Similar values were found in mechanically ventilated ICU patients without ARDS (group A) on admission (right LMVPI 3.2 +/- 2.6, left LMVPI 2.6 +/- 2.7%/h) and 4 days later (right LMVPI 3.9 +/- 2.6, left LMVPI 2.3 +/- 1.8%/h). Interestingly, the initial evaluation of patients with direct early posttraumatic ARDS (lung contusion) (group B) showed significantly (p less than .01) elevated LMVP for the contused side (LMVPI 10.8 +/- 5.1%/h), but normal values for the nontraumatized lung (LMVPI 3.9 +/- 3.4%/h), whereas 4 days later the LMVP increased significantly (p less than .05) on the primarily healthy side (LMVPI 8.0 +/- 5.0%/h) while remaining elevated for the traumatized lung (LMVPI 10.9 +/- 6.0%/h).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Weaning an asthmatic using biphasic positive airway pressure together with continuous sufentanil administration].

A patient presenting with acute severe asthma associated with protracted hypoventilation (paCO2 = 90 mmHg) and impaired consciousness underwent sedation and controlled mechanical ventilation. The peak airway pressure could be reduced by constant-volume mechanical ventilation and analgosedation with midazolam and ketamine. When the gas exchange had stabilized, the first attempt at weaning was made by synchronized intermittent mechanical ventilation (SIMV). After this and two other attempts had failed, the patient was given continuous sufentanil (0.8-1.0 micrograms/kg), as well as additional bolus injections of 2 micrograms/kg and 0.35 micrograms/kg for analgosedation. Controlled mechanical ventilation was replaced by the system of biphasic positive airway pressure (BIPAP). The mechanical ventilatory support was gradually reduced, as was the dose of continuous sufentanil. Extubation was possible at a dose of 0.2 micrograms/kg per h sufentanil and CPAP. From this case, it is not possible to determine whether the BIPAP system or the analgosedation with Sufentanil was the decisive factor in the therapeutic success. It may well have been the combination of both therapeutic measures that--in our opinion--supplemented each other in an ideal way.

Fentanyl↗
PubMed1990

[Acute lung failure following thoracic trauma].

Pulmonary failure is almost always present in the early or late phase of multiple organ failure (MOF). Acute lung failure (ALF) is a uniquely constant response to direct or indirect insults to the lung. Increased pulmonary microvascular permeability (PMVP) is associated with the onset of lung permeability edema, the hallmark of ALF. The sequence of PMVP and the development of ALF caused by direct insults are studied. METHODS. A series of 255 trauma patients admitted to our intensive care unit (ICU) from 1987 to 1988 were enrolled in this prospective study. ALF was defined as stage III of the Posttraumatic Pulmonary Insufficiency Score; sepsis syndrome, according to Montgomery; organ failure, as stage II of the MOF score, and MOF was recorded when at least two organs had failed. Thoracic injury and aspiration were expected as direct, sepsis and shock alone as indirect insults to the lung. A computerized large field of view gamma camera was used to measure PMVP simultaneously over both lungs by means of 113mIn-transferrin and 99mTc-erythrocytes. The pulmonary microvascular permeability index (PMVPI; %/h) was used to quantify PMVP in the dynamic scintigraphic measurement. RESULTS. Of the 255 trauma patients (ISS = 33.9 +/- 18.7), 21% (52) patients (ISS = 41 +/- 17.8) developed ALF. 50 (or 96%) of the ALF patients developed MOF in addition, and 27 (72%) of the patients with directly induced ALF developed sepsis syndrome later. Direct lung injury was present in 77% (37) of the patients with posttraumatic ALF. Thoracic injury was the main cause of ALF: 58% (30) of 52 patients with ALF had a thoracic injury, which was true of only 30% of the non-ALF group (P less than 0.05). 33 (or 89%) of the ALF patients with direct injury developed ALF less than 72 h after injury (early ALF), and only 11% (4) later than 72 h after injury (late ALF). Indirect injury of the lung was present in 22% (12) of the patients with posttraumatic ALF. Indirectly induced ALF occurred in less than 72 h in 36% (4) and more than 72 h after injury in 64% (7) trauma patients. PMVP was determined in 21 of the 30 patients with thoracic injury. Initial evaluation of these patients with direct induced ALF showed significantly elevated (P less than 0.01) PMVP for the traumatized (PMVPI = 10.8 +/- 5.1%/h) but normal values for the nontraumatized lung (PMVPI = 3.9 +/- 3.4%/h), whereas 4 days later the PMVP increased significantly (P less than 0.05) on the primarily healthy side (PMVPI = 8.0 +/- 5.0%/h) while remaining elevated for the traumatized lung (PMVPI = 10.9 +/- 6.0%/h). In the control group the PMVPI was 2.6 +/- 2.8%/h for the right and 2.0 +/- 2.8%/h for the left lung. Similar values were found in mechanically ventilated ICU patients without ALF. DISCUSSION. Direct injury seems to be the dominant mechanism for early manifestation (less than 72 h) of posttraumatic ALF. The thoracic trauma seems to damage the pulmonary endothelium directly, thus increasing PMVP in a circumscribed region. An overwhelming inflammatory response may cause the later increase in PMVP in the primarily healthy lung areas.

Acute Disease↗
PubMed1990

[The course of extravascular lung water in severely injured patients in intensive care with and without thoracic trauma].

In patients with multiple injuries, the development of permeability edema can be assumed. However, no uniform shape of this fluid accumulation can be found even in the presence of severe injuries. Based on the first clinical observations, our aim was to search for correlations between the development of extravascular lung water (EVLW) and the individual injury pattern in severely traumatized ICU patients. PATIENTS and METHODS. Our investigations were performed in 48 artificially ventilated ICU patients. According to the prevailing injury pattern patients were divided into three groups: group A: 18 patients (mean age: 32 years, mean Injury Severity Score (ISS) = 29) with isolated thoracic trauma; group B: 10 patients (mean age: 27 years, mean ISS = 42) with severe multiple trauma but without any thoracic injury; group C: 20 patients (mean age: 33 years, mean ISS = 43) with severe multiple trauma and concomitant thoracic trauma. In all patients (group A, B, C), EVLW was determined by means of a double indicator method on a daily basis from the patient's admission to the ICU (day of trauma) until day 10. Additionally, the hemodynamic parameters (heart rate, mean arterial pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and cardiac index) were determined at the same time. RESULTS. As shown in Fig 1, EVLW was slightly elevated on day 1. However, on day 2 EVLW decreased within normal values and remained in that range until the end of the observation period. On day 3 a slight and fleeting increase of EVLW, but within normal range, can be seen. In group B (Fig.2), EVLW can be observed within normal range within a period of 4 days. Starting from day 5 until day 7 a marked increase (p greater than 0.01) in EVLW can be seen. From that maximum point EVLW development reverses slightly until day 10--however, without returning to the normal range. In group C, a marked biphasic pattern can be seen due to EVLW maximum values on post-traumatic days 3 and 7. However, in this group the EVLW was in the pathological range during the whole observation period. No statistically significant differences could be seen, when looking at hemodynamic variables. CONCLUSION. Isolated thoracic trauma will not lead to a marked pathological elevation of EVLW within the lungs. Moreover, EVLW decreases rapidly within a short time period. Based on our results, it seems that severe extrathoracic injuries will intensify microvascular injury in the initial period, as shown in our patients in group C. Increase of EVLW at a later time (day 7), as observed in groups B and C, is possibly the expression of a mediator and activator-induced "septiformal" injury of the microvascular endothelium. This may be caused by the underlying massive peripheral soft-tissue trauma. Specific elevations of EVLW subsequent to the individual injury pattern can indicate that that process has begun and is responsible for the origin of the microvascular injuries.

Adolescent↗
PubMed1989

Influence of high frequency ventilation at different end-expiratory lung volumes on the development of lung damage during lung lavage in rabbits.

The effects of high frequency ventilation in combination with sustained inflations was studied in the surfactant-deficient lungs of 18 New Zealand White rabbits (weight 1.9-2.1 kg) during anaesthesia with urethane and neuromuscular block with pancuronium. Lung damage was induced by repeated lung lavage. In nine rabbits (group I) baseline ventilator settings were maintained constant throughout the study and airway pressure was readjusted to achieve a constant tidal volume. In the other nine rabbits (group II), ventilation was reinstituted after lung lavage with one period of four sustained inflations followed immediately by high frequency ventilation. In group I there was a significant decrease in gas exchange for oxygen and deterioration in pulmonary mechanics, whereas in group II there was little change in baseline blood-gas values or pulmonary mechanics. These data suggest that, with adequate ventilatory management during the period of lung lavage, the lung damage produced by this manoeuvre may be obviated.

Anesthesia, Intravenous↗
PubMed1989

[The PEEP wave: an automated technic for bedside determination of the volume/pressure ratio in the lungs of ventilated patients].

The volume/pressure (V/P) ratio in the lungs has been reported to be useful in the adjustment of mechanical ventilation equipment to suit individual pulmonary mechanics. Most of the techniques used so far (e.g. the super-syringe technique) need an apneic period of approximately 60-120 s, in which the pulmonary gas volume is reduced by the continuing oxygen uptake. Thus, a bias of 200-400 ml in volume is superimposed on the record. In contrast to the super-syringe technique, a new automatic procedure has been developed for which no apneic period is needed. This technique is called the PEEP wave technique: it is based on the imbalance between inspiratory and expiratory volumes after a sudden change in PEEP. The software of a Dräger Evita respirator was adapted to allow automatic application of a special sequence of respiratory cycles with stepwise increase and decreases in PEEP between two preselectable borderline levels. The equipment is switched to the next PEEP level when the difference between two consecutive expiratory tidal volumes is less than 15 ml. After the highest level of PEEP is reached the procedure is reversed until PEEP returns to its initial value. Constant inspiratory tidal volumes (Vti) are achieved by a high pressure servo valve (HPSV) under conditions of chocked flow, resulting in inspiratory tidal volumes which are independent of back-pressure. Thus, only the difference in expiratory tidal volumes (Vte) before and after a PEEP change is necessary to determine gain and loss in lung volume (delta FRC).(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

[Biphasic positive airway pressure (BIPAP)--a new form of augmented ventilation].

Two modes of combining spontaneous breathing and mechanical ventilation are already in use: periodic mechanical support always followed by a period of spontaneous breathing (intermittent mandatory ventilation; IMV) and mechanical support of each spontaneous breath (inspiratory assistance; IA). Biphasic positive airway pressure (BIPAP), in contrast, is based on neither of the above mentioned principles. It is rather a mixture of pressure controlled (PC) ventilation and spontaneous breathing, which is unrestricted in each phase of the respiratory cycle. The BIPAP circuit switches between a high (Phi) and a low (Plo) airway pressure level in an adjustable time sequence. At both pressure levels the patient can breathe spontaneously in a continuous positive airway pressure system (CPAP). The volume displacement caused by the difference between Phi and Plo and the BIPAP frequency (F) contribute the mechanical ventilation to total ventilation. Duration of the Phi and the Plo phases can be independently adjusted. Similar to the I:E ratio during controlled ventilation, the phase time ratio (PhTR) is calculated as the ratio between the durations of the two pressure phases. A PhTR greater than 1:1 is called IR-BIPAP. A BIPAP system can be set up either as a continuous flow system, or as a demand valve system. A continuous-flow BIPAP system consists of a high-flow CPAP system, a reservoir bag, and a pneumatically controlled membrane valve in the expiratory limb. A magnetic valve operated by an impulse generator switches between Phi and Plo, controlling the pop-off pressures of the expiratory valve.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1987

[Treatment of re-expansion edema ('unilateral ARDS") after rapid pneumothorax drainage].

A rare complication after delayed re-expansion of pneumothorax is reported. A polytraumatized patient with stable vital functions was admitted to our ICU immediately after surgery. Later, oxygenation worsened treated by a rise in FiO2. Concomitant tachycardia was thought to be due to increasing body temperature. On day 3 of treatment in the ICU further deterioration in gas exchange (and in hemodynamics, with complete collapse of the left lung) was diagnosed on X-ray examination. Retrospectively, the development of this condition could be traced on the X-ray films taken during the previous 3 days. Thoracic drainage and suction resulted in complete re-expansion of the lung. After re-expansion worsening of gas exchange and unilateral ARDS-like configurations were observed on chest X-ray. Reversal of the I:E ration and a rise in PEEP improved gas exchange and the X-ray appearance immediately. In the next few days the intensity of the respiratory treatment could be reduced, and after a short period of CPAP the patient was discharged from the ICU. Three mechanisms for development of this "unilateral ARDS" are discussed: loss and suppressed regeneration of surfactant in prolonged atelectic alveolar compartments; increased capillary fluid escape due to suction; and increased complement activation and reduced degradation of edematogenic bradykinin in hypoxic alveolar compartments. Possible clinical implications for the treatment of longer duration pneumothorax are: fractionated drainage and respirator settings, reopening collapsed alveoli in an inhomogeneously diseased lung such as IRV.

Adult↗