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Biomedical subjects

D Eimerl

Publications and source records attributed to D Eimerl.

28 records · Page 2Linked to original sources
PubMed1978

The variable effect of PEEP in acute respiratory failure associated with multiple trauma.

Both short and longterm effects of positive end-expiratory pressure (PEEP) on oxygenating capacity (OC) were investigated in three groups of patients with acute respiratory failure following multiple trauma (MT). Group A consisted of six patients with "uncomplicated" MT; Group B, eight patients with MT and generalized sepsis; Group C, nine patients with MT and lung contusion. OC was evaluated in terms of PaO2/FIO2 and P(A-a)DO2 on FIO 2 = 1.0. OC was markedly and equally reduced in the three patient groups before use of PEEP. The use of a mean PEEP of 6-7 cm H2O resulted in an initial improvement in mean PaO2/FIO2 of 152.5, 36.1, and 59.2 mm Hg, and an overall improvement of 196.8, 57.5, and 107.0 mm Hg in Groups A, B, and C, respectively. There was a similar improvement in both the initial and the overall effect of PEEP on P(A-a)DO2 in the three groups. The difference in the improvement in OC due to PEEP was statistically significant between Groups A and B. It is concluded that acute respiratory failure following MT includes a wide spectrum of clinical syndromes, and that the improvement in OCT due to PEEP depends on the clinical sydrome that is responsible for the respiratory failure associated with MT.

Acute Disease↗
PubMed1978

The marked myocardial depressant effect of verapamil.

An experiment was designed to measure accurately the primary effect of verapamil on myocardial contractility by infusion of the drug directly into the coronary artery of open-chested anesthetized dogs. A marked myocardial depressant effect, which was dose and time dependent, was noted during verapamil infusion at the infused area only. The percent decrease in contractile force ranged from 8.8 at an infusion rate (mg/min) of 0.55 X 10(-2) to 36.8 at 5.5 X 10(-2). Similar changes were observed in the first derivative of the contractile force. No changes were observed in the left ventricular systolic or end-diastolic pressure and only a mild increase in contractile force was noted in the control (noninfused) area. The depressant effect of verapamil was sustained. Recovery time after 5 min of verapamil infusion was dose dependent, ranging from 10 to 45 min. During the recovery period, an overshoot of the contractile force was observed in dogs on the higher doses only. We concluded that verapamil in clinically relevant doses has a marked negative inotropic effect of long duration and therefore should be used with caution in patients with depressed left ventricular function. Cessation of the verapamil treatment may cause a transient increase in myocardial contractility, which might be hazardous in patients with angina pectoris who have compromised coronary blood flow.

Animals↗
PubMed1977

Cardiopulmonary effects of volume loading in patients in septic shock.

The effect of volume loading in 20 patients with clinical and bacteriological evidence of generalized sepsis was studied. The patients were divided into two groups according to their response to volume loading. Group A included 9 patients in whom the initial pulmonary capillary wedge pressure (PWP)was lower than the central venous pressure (CVP). In this group the intravenous administration of 5089+/-409ml/24 hr fluids was accompanied by a significant rise in blood pressure from 94.4+/-9.3mm Hg to 118.9+/-6.3 MM Hg with no significant change in pulse rate or CVP. PWP rose from 5.7 +/- 1.8 to 10.0 +/- 1.4. The rise in cardiac output from 8.0+/-1.3 liter/min to 9.7+/-1.1 liter/min was not statistically significant. Group B included 11 patients in whom the initial PWP was higher than the CVP. In this group, signs of fluid overloading appeared after administration of 3151+/-540ml/24 hr. There was no significant change in blood pressure, pulse rate, CVP, PWP or cardiac output. Urine output was adequate in both groups. This volume load did not affect pulmonary oxygenating capacity (PaO2/F1O2) and effective lung compliance in both groups, but the maintenance of an unchanged oxygenating capacity necessitated an increase in PEEP in some patients. Thus, synchronous monitoring of PWP and CVP in septic shock is helpful in selecting patients (Group A) who will best respond to fluid loading without deterioration of pulmonary oxygenating capacity. PEEP ventilation may be necessary in some patients to maintain the favorable effect of volume loading.

Adult↗
PubMedDate not supplied

Direct positive inotropic effect of mannitol on the intact canine heart.

Infusion of 25% mannitol into either the circumflex or left anterior descending coronary artery caused a significant increase in myocardial force development, measured by means of strain gauge in 10 anesthetized dogs. The changes were confined to the area perfused. The increase in developed force was dose-dependent, 20% at an infusion rate of 0.55 ml/min, 28% at 1.4 ml/min, 32% at 2.8 ml/min and 57% at 5.5 ml/min. There was a similar increase in dF/dt. The increase in developed force in the first minute was also dose-dependent, being 9% at 0.55 ml/min and 40% at 5.5 ml/min. No change in developed force occurred in the control (non-perfused) area or during saline infusion of the same artery at similar rates. A decrease in developed force of 10.5% was observed after the initial rise when mannitol was infused at 5.5 ml/min. This effect did not completely abolish the initial increase. No change in blood pressure, heart rate, LV systolic and diastolic pressure of LV dp/dt occurred during the experiment. It is concluded that doses of mannitol which are in clinical use have a direct positive inotropic effect on the intact canine heart.

Animals↗
PubMedDate not supplied

The effect of PEEP on oxygenating capacity in acute respiratory failure with sepsis.

We report an evaluation of the effect of postive-end-expiratory-pressure (PEEP) on improving pulmonary oxygenating capacity in the adult respiratory distress syndrome (ARDS), when the latter is associated with generalized gram-negative sepsis. Fifty-seven cases treated in our RICU with PEEP ventilation (April 1972 to January 1975) were retrospectively reviewed. Oxygenating capacity improvement was evaluated in terms of the changes in PaO2/FIO2 and AaDO2 (FIO2 = 1.0). Both the short term (2-3 hours from the initiation of PEEP) and the overall effects of PEEP were evaluated. A mean PEEP of 5.6 cm H2O initially increased PaO2/FIO2 by a mean of 94 torr and decreased AaDO2 (FIO2 = 1.0) by 105 torr in the 28 nonseptic patients. In the 29 septic patients, 5.1 cm H2O PEEP initially increased PaO2/FIO2 by 32 torr and decreased AsDO2 (FIO2 = 1.0) by 38 torr. The differences between the septic and nonseptic patients were statistically significant (P less than 0.001). Likewise, the long-term effect of similar levels of PEEP was in increasing PaO2/FIO2 by 142 torr and by 75 torr in the nonseptic and septic patients, respectively. The final reduction in AaDO2 (FIO2 = 1.0) was 163 torr and 87 torr in the nonseptic and septic patients, respectively. These differences between patient groups were also statistically significant (P less than 0.02). Mortality during PEEP was 15/29 and 3/28 in the septic and nonseptic patients, respectively. Overall mortality in the septic and nonseptic groups was 18/29 and 5/28, respectively. We conclude that ARDS with sepsis constitutes a more severe pulmonary insult than ARDS without sepsis, and/or that generalized sepsis creates a more prolonged pulmonary insult that makes it less amenable to PEEP. Thus, high levels of PEEP may be needed to treat ARDS associated with sepsis.

Adolescent↗
PubMedDate not supplied

Aberrant position of a central venous catheter: a cause for inadequate fluid replacement in septic shock.

An unusual placement of a "central" venous catheter in the porto-hemiazygous system of a cirrhotic patient in septic shock is described. The catheter was misinterpreted as being located in a central vein and served initially as a guide for volume replacement. The high central venous pressure recorded (22 cm H2O) in spite of signs of hypovolemia led to the introduction of a Swan-Ganz catheter which confirmed the presence of hypovolemia. The proper position of the central venous catheter, especially in cirrhotic patients, should not only be confirmed by plain chest x-ray but also by injection of contrast medium.

Adult↗