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Biomedical subjects

C Spiss

Publications and source records attributed to C Spiss.

12 recordsLinked to original sources
PubMed2001

Continuous beta-lactam antibiotic therapy in a double-lung transplanted patient with a multidrug-resistant Pseudomonas aeruginosa infection.

BACKGROUND: It is well known that the bactericidal effect of beta-lactam antibiotics is closely related to the time which the serum concentration of the antibiotic remains above the minimal inhibitory concentration of the target pathogen. Thus, the optimal administration of beta-lactam antibiotics would be the continuous infusion of the drug. METHODS: We present a case report with a critically ill double-lung transplanted patient with pneumonia due to a multidrug-resistant Pseudomonas aeruginosa who received continuously 8 g meropenem/24 hr. Based on a previous pharmacokinetic study showing that continuous infusion of meropenem is at least equivalent to intermittent administration this case report is reported to demonstrate the clinical efficacy of continuous infusion. RESULTS: C-reactive protein and pneumonia decreased rapidly when clinical conditions were improved significantly. Continuous administration of meropenem did not interfere with cyclosporine, no side effects were seen, and the patient's renal function was not impaired during the whole period of treatment. CONCLUSION: The continuous administration of beta-lactam antibiotics is a powerful application in critically ill patients to intensify antimicrobial therapy.

Anti-Bacterial Agents↗
PubMed1997

Validity of acoustic quantification colour kinesis for detection of left ventricular regional wall motion abnormalities: a transoesophageal echocardiographic study.

Transoesophageal echocardiography is a sensitive monitor for intraoperative myocardial ischaemia. Colour kinesis is a new technology for echocardiographic assessment of regional wall motion based on acoustic quantification. We have examined the feasibility and accuracy of quantitative segmental analysis of colour kinesis images to provide objective evaluation of systolic regional wall motion during the perioperative period using transoesophageal echocardiography (TOE). Two-dimensional echocardiograms were obtained in the transgastric short-axis and long-axis views in 60 patients with coronary artery disease undergoing noncardiac surgery. End-systolic colour overlays superimposed on the grey scale images were obtained with colour kinesis to colour encode left ventricular endocardial motion throughout systole. These colour-encoded images were divided into segments and compared with corresponding conventional two-dimensional images. Six hundred of a potential 720 left ventricular wall segments were of sufficient resolution for grading by experts; they diagnosed wall motion abnormalities in 61 of these segments by a conventional method. In comparing the conventional TOE method with colour kinesis, there were 60 true positives, 482 true negatives, 57 false positives and 1 false negative result. This yielded a sensitivity of 98%, specificity of 89%, positive predictive value of 51% and negative predictive value of 100%. Translational and rotational movement of the heart and papillary muscle interference were common problems accounting for false positive diagnoses. We conclude that colour kinesis provides a basis for objective and on-line evaluation of left ventricular regional wall motion which is a sensitive but non-specific method. It may be a useful aid for the less experienced because it can potentially direct the anaesthetist's attention towards specific segments.

Adult↗
PubMed1993

Central nervous system function after cardiopulmonary bypass.

In a prospective study, an elderly group of patients (n = 63, 47 male, 16 female, age 40-65 years) was examined before and after open-heart surgery under cardiopulmonary bypass: postoperatively, 19 patients (30%) showed no clinical neuropsychiatric symptoms, whereas in 35 patients (56%) mild or transient neurological signs and in nine (14%) severe neurological complications were found. The postoperative EEG changes were characterized by a slight delta-theta increase, an alpha decrease and a significant slowing of the dominant frequency from 9.7 to 9.3 Hz. In brainstem auditory evoked potentials no changes were found, and in somatosensory evoked potentials (median nerve) the latency of the early cortical component, N20, increased. Cardiovascular reflexes showed increased changes, similar to those found in autonomic neuropathies. In the neuropsychological test battery, the Visual retention test (Benton) and the Rorschach test showed slight postoperative improvement, whereas other psychometric variables (flicker fusion frequency, reaction time) did not change. Despite an improved operative technique some minor clinical and neurophysiological disturbances of the central nervous system remain. However, specific pre- or peri-operative risk factors for these postoperative disturbances or complications could not be identified.

Adult↗
PubMed1991

[Neurologic and psychiatric complications after heart surgery].

In 63 patients undergoing heart operations with extracorporeal circulation (47 males, 16 females, mean age 54 years; coronary artery bypass in 38 cases, valvular surgery in the rest) postoperative neurological and psychiatric complications were evaluated. 18 patients (29%) had no complications, whereas 35 patients (56%) showed minor or transient neurological symptoms, and 9 patients (14%) exhibited severe symptoms. Nine of the patients had slight psychiatric disturbances (affective disturbances, disorientation). No correlation was found between risk factors (age, nicotine abuse, hypertension, hypercholesteremia, neurologic and cardiac history), intraoperative parameters (duration of extracorporeal bypass, aortic clamp time, deviation of mean arterial pressure), postoperative parameters (internal complications) and the complication rate. Therefore no predisposing factors could be identified.

Adult↗
PubMed1988

Topographic brain mapping of EEG before and after open-heart surgery.

The brain function of 60 patients undergoing open-heart surgery (36 patients receiving coronary artery bypass, 21 patients valve replacements, 3 both) was investigated before and 10 days after the operation utilizing topographic brain mapping of the electroencephalogram (EEG). The postoperative EEG changes were characterized by a slight delta-theta increase, an alpha decrease [especially in the fast alpha (10.5-13 Hz) band] and a beta increase in the relative power. The total power and the absolute power of the delta-theta, alpha and beta showed a decrease, the dominant frequency a significant slowing from 9.7 to 9.3 Hz. The centroid of alpha and beta activity decreased as well. These results are similar to findings obtained in patients with organic brain syndrome. The EEG changes were prominent over the left hemisphere, which may be of particular clinical relevance.

Adult↗
PubMed1984

[Control of spontaneous respiration with continuous positive airway pressure using transthoracic electrical impedance. Studies in subjects with healthy lungs].

A clinically practicable method for the control of intrapulmonary gas volume changes for patients with spontaneous respiration and CPAP has been evaluated. Changes of intrapulmonary gas volume caused by different continuous positive air-way pressures (CPAP) can be monitored sufficiently using a noninvasive technique of transthoracic electrical impedance (Z0). In 24 healthy volunteers Z0 (rheography) was measured. After stepwise increase of CPAP from 5-20 cm H2O a significant increase of Z0 could be observed. Z0 pressure relations, detected by regression analysis showed a correspondence of intrapulmonary gas filling changes and volume/pressure relation. We therefore conclude that the control of Z0 pressure relationship for the calculation of the maximum is of some importance for determination of therapeutic levels of CPAP.

Adult↗
PubMed1984

[Indications for tracheotomy in long-term ventilated critically ill patients].

In order to evaluate the frequency and indication of tracheotomy in long-term ventilated critically ill patients we analysed retrospectively patients requiring artificial ventilation for periods of more than 7 days. During 1974-75 30 out of 55 of these patients were tracheotomised. In accordance with common practice, early tracheotomy (14 patients) was performed when ventilatory support was expected to exceed 8 to 10 days. In another 16 cases, the same limits were applicable for terminating prolonged tracheal intubation in favour of tracheotomy. In contrast, during the period 1980-81 tracheotomy had been indicated in 8 out of 94 patients. Early tracheotomy was limited to four patients with severe facial injuries accompanied by acute lung failure. The decision to perform tracheotomy or to continue prolonged tracheal intubation was based on definite findings during direct laryngoscopy and fibre bronchoscopy examination of the airways. No late laryngeal sequelae after prolonged tracheal intubation were observed. The risks have been reduced by the use of recently introduced tube materials. Prolonged tracheal intubation has become a safe alternative to tracheotomy.

Critical Care↗
PubMed1983

[Weaning postoperative artificial respiration in cardiac surgery patients, CPAP versus ZEEP].

Pulmonary lesions following extracorporeal circulation (ECC) are said to be responsible for decreased functional residual capacity (FRC). Weaning from controlled mechanical ventilation (CMV) in the postoperative period is commonly performed by a CPAP system in order to restore the impaired oxygen exchange. Testing the superiority of CPAP against insufflation at atmospheric pressure (ZEEP), 33 patients after coronary bypass grafting (CABG) underwent from the end of CMV till extubation either CPAP or ZEEP in a randomized distribution. Data sampling included respiratory rate, paO2, paCO2 and AaDO2-Quotient (gas exchange), as well as HR, MAP, CVP and LAP (hemodynamics). None of the obtained data showed statistical significant differences between the CPAP and the ZEEP group. Therefore there appears to be no necessity for CPAP when weaning CABG patients, due to the absence of previous lung damage and the short time range of intubation and CMV.

Air Pressure↗
PubMed1981

[The influence of oxygen and bicarbonate administration to the parturient on maternal and fetal blood gases and acid base balance (author's transl)].

The effects of oxygen and bicarbonate administration to parturients were studied by analysis of maternal and fetal blood gas parameters. Oxygen inhalation resulted in a significant increase of the fetal pO2 and appears to be a practicable mean of intrauterine reanimation of hypoxic fetuses. Intravenous bicarbonate was unable to raise the fetal pH. Simultaneous bicarbonate and oxygen administration had no desirable effects on the fetal acid-base-balance.

Acid-Base Equilibrium↗
PubMed1981

[A new adaptor for endotracheal tubes to permit suction without interrupting artificial ventilation (author's transl)].

A new side-hole adapter (C/D SUCTION ADAPTER, Novametrix Medical System) enables tracheobronchial suctioning during uninterrupted mechanical ventilation. Compared to conventional end-hole suctioning techniques a significantly smaller drop of arterial pO2 during suctioning procedures was found. Additional advantages e.g. reduced formation of microatelectasis, improved expulsion of bronchial secretion and lower risk of tracheal mucosa lesions by the catheter tip are discussed.

Humans↗