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D Köhler

Publications and source records attributed to D Köhler.

At least 109 records · Page 6Linked to original sources
PubMed1997

[Nasal strips without effect on obstructive sleep apnea and snoring].

Recently a nose plaster (NP, Breathe-Right) has been increasingly used in the treatment of obstructive sleep apnoea (OSA) and snoring. Hence, we examined the use of the NP as a treatment of both OSA and snoring without OSA. The NP has a elastic spine that increases the diameter of the nostril and is thought to reduce the degree of OSA and snoring. According to the polysomnographic data two groups were differentiated: Group A (30 patients with OSA, apnoea index > 10/h, 26 men) and Group B (20 snorers, without OSA, 13 men). After the diagnostic polysomnography the efficacy of the NP was measured with a cardiorespiratory polygraph on the 2 following nights. In the group A the polygraphic data (apnoea index, time of apneas, desaturation index, time of desaturations, mean and nadir SaO2) were studied; in group B the snoring index (snoring events/hour) was measured. A questionnaire scored quality of sleeping, daytime condition and the quality of nose breathing. In neither group were the recorded polygraphic findings different with the NP although with the NP an improved nose breathing was scored in both groups. In group A 90% of the patients scored the daytime sleepiness unchanged and 10 of 30 patients described an improved quality of sleep. In group B there was no change in the frequency of snoring events with the NP. Neither the degree of OSA nor of snoring without OSA were changed by the NP, which can therefore not be considered a treatment of these conditions. However, the majority of the study population were impressed by the symptomatic improvement in nose breathing.

Dilatation↗
PubMed1997

[Changes in the time spent awake in obstructive sleep apnea and snoring--results of a pilot study].

Continuous positive airway pressure (CPAP) therapy reduces sleeping time per day and daytime sleepiness in obstructive sleep apnoea (OSA) and heavy snoring. Due to sleep fragmentation the OSA and heavy snoring are associated with a daytime sleepiness and increased necessity of sleep. In this pilot study the effect of CPAP-therapy on daytime sleepiness and sleep time during 24 hours were assessed in patients with OSA or heavy snoring (daytime sleepiness, none or slight apnoea with AHI < 10/h and benefit of CPAP). We studies 42 patients with OSA (AHI: 34.5 +/- 23.6) and 15 patients with heavy snoring: inclusion criteria: Patients with OSA (AHI > 10/h, ESS-Score > 8) and heavy snoring (AHI < 10/h, ESS-Score > 8) who were treated with nCPAP. Before and 2 months after initiation the CPAP-therapy all patients completed diary cards recording the sleeping time/day for 1 month; additionally they scored sleepiness using the Epworth sleepiness scale (ESS-score ranged from 0 to 24, the higher the score the worse the sleepiness) before and 2 months after initiation the CPAP-therapy. In the whole study population nCPAP-therapy reduced the sleeping time significantly by a mean period of 46 minutes per 24 hours (from 8.3 +/- 1.3 to 7.5 +/- 1.2 hours, p < 0.001) and improved the ESS score from 13.7 +/- 4.6 to 6.1 +/- 3.6 (p < 0.0001). In respect of the change of sleeping time/day and of the sleepiness score there was no significant difference between the OSA and heavy snoring group. With CPAP the AHI in OSA patients was reduced from 34.5 +/- 23.6/h to 3.2 +/- 3.2/h. Due to the improvement of sleep-related breathing disorders CPAP therapy reduced the mean sleeping time/day by approximately 10% and the daytime sleepiness score both in patients with OSA and heavy snoring compared to the pretreatment period.

Airway Obstruction↗
PubMed1997

[Ergometry separates sleep apnea syndrome from obesity-hypoventilation after therapy positive pressure ventilation therapy].

In contrast to the obstructive sleep apnoea syndrome (OSA) the obesity-hypoventilation syndrome (OHS) is characterized by persistent hypercapnia during the day. After positive pressure ventilation (PPV) patients with OHS the daytime blood gases normalize after a short time. The aim of this study was to investigate whether blood gases at the end of a standardized exercise test separate both OSA and OHS after 3 months of PPV. Fourteen patients with OHS (12 males, 53.2 +/- 9.5 years, BMI: 41.7 +/- 9.6 kg/m2, PCO2: 50.7 +/- 4.5 mmHg) and 28 patients with severe OSA (27 males, 54.5 +/- 8.3 years, BMI: 35.7 +/- 4.9 kg/m2, PCO2: 37.3 +/- 3.3 mmHg) were studied. Blood gases before and after 4 minutes constant load exercise test were measured. The exercise level for patients with OSA was 2/3 of the predicted maximal work load. Since in OHS the load tolerance was compromised, the exercise test was performed at 2/3 of the maximal exercise level which was investigated before. The identical exercise load was done before and 3 months after beginning the PPV. Compared to the OSA-group the load tolerance of the OHS-group was lower (112 +/- 20 Watt [2/3 of predicted maximal work load] versus 81 +/- 26 Watt [39.9 +/- 8.3% of predicted maximal work load], p < 0.0001). Both before and after 3 months of PPV all patients with OHS showed an exercise induced increase of PCO2 (Before PPV: from 50.7 +/- 4.5 to 56.6 +/- 5.8 mmHg; after PPV: from 39.1 +/- 2.7 to 45.6 +/- 2 mmHg, each p < 0.0001). Correspondingly the PCO2 decreased significantly. In OSA neither before nor after 3 months PPV the blood gases changed significantly during the exercise test. We conclude that the OHS associated hypercapnia during exercise is further on a reliable indicator for the diagnosis despite the daytime normocapnia during rest after PPV. However after PPV the PCO2-values of patients with OHS at rest are in the normal range.

Airway Obstruction↗
PubMed1996

[Acetylcysteine].

Explore the source record for details and available documents.

Acetylcysteine↗
PubMed1996

[Intermittent self-ventilation in torsion scoliosis. Possibilities and limits].

BACKGROUND: In patients with hypercapnic respiratory failure due to restrictive lung diseases home mechanical ventilation leads to improvement of daytime blood gases and symptoms. In this paper we regard the possible pitfalls and complications associated with intermittent mechanical ventilation in patients with kyphoscoliosis. PATIENTS AND METHODS: From 1990 to 1994 we treated 30 patients suffering from severe kyphoscoliosis with home mechanical ventilation. RESULTS AND CONCLUSIONS: 1. As our cases show in the prehospital phase before initiating home mechanical ventilation there is still room for the outpatient pneumologists to improve their knowledge and awareness of symptoms and treatment of chronic respiratory failure. 2. In the subsequent inpatient phase and specialised center must be aware and experienced in regarding possible problems inherent with home mechanical ventilation. 3. After discharge during chronic home mechanical ventilation a good cooperation between the center, patient, relatives, general services and general pulmolgists is necessary. The centers should offer training courses for the caring persons and general pneumologists.

Adult↗
PubMed1996

[Intermittent self-ventilation after respirator weaning].

BACKGROUND: Weaning from the mechanical ventilator often proves to be difficult after prolonged ventilation due to excessive load or decreased capacity of the respiratory muscles. In the present retrospective study we examined the impact of the nocturnal mechanical ventilation during the "post-weaning-period" of long-term ventilated patients. PATIENTS AND METHODS: We studied 43 patients (23 men, 59.1 +/- 14.6 years) with chronic respiratory failure who were transmitted from external ICUs after a mechanical ventilation period of 57.5 +/- 60.3 days. The weaning regime consisted of an individually adapted volume-cycled ventilation. If the patients were hypercapnic (pCO2 > 48 mm Hg) after the first 24-hour-period of spontaneous breathing without supplemental oxygen nocturnal mechanical ventilation was initiated. RESULTS AND CONCLUSIONS: In a retrospective study we could show that the decision to initiate invasive or noninvasive nocturnal mechanical ventilation after successful weaning primarily depends on the question whether a chronic hypercapnic respiratory failure persisted also after weaning from long-term mechanical ventilation. In about 40% of unselected patients nocturnal mechanical ventilation stabilized the weaning success whereas 60% of the patients did not need any further nocturnal mechanical ventilation.

Adult↗
PubMed1996

Long-term lung sequelae following accidental chlorine gas exposure.

Acute exposure to sublethal doses of chlorine gas resulted in persistent pulmonary symptoms in 3 patients who had no past history of respiratory disease. The patients complained of intermittent dyspnea in association with respiratory irritants and physical exertion for more than 2.5 years postexposure. Four months after the accident bronchoalveolar lavage showed an inflammatory cell reaction, whereas 16 months later the differential cytology proved nearly normal. Moderate to severe nonspecific bronchial hyperresponsiveness was assessed in intervals of 4, 20 and 30 months after the accident. All patients showed the typical features of the reactive airways dysfunction syndrome defined as an asthma-like occupational illness after an acute exposure to highly concentrated respiratory irritants. We conclude that a single high exposure to chlorine gas may lead both to acute respiratory injury and to long-term reactive airway dysfunction with typical symptoms of inflammatory changes of the airways and nonspecific bronchial hyperresponsiveness.

Accidents, Occupational↗
PubMed1996

Benzodiazepine receptor antagonist (flumazenil) does not affect sleep-related breathing disorders.

Benzodiazepine drugs may impair breathing during sleep, leading to the development of sleep-disordered breathing or, in subjects with sleep apnoea, an increase in the severity of pre-existing apnoeas. Flumazenil is a selective benzodiazepine-antagonist. We hypothesized that endogenous ligands of benzodiazepine receptors might contribute to the pathogenesis of obstructive sleep apnoea syndrome (OSAS) and that the intensity of OSAS could, therefore, be reduced by flumazenil. Ten male patients (mean age 55 yrs, mean body mass index 42.4 kg.m-2, mean apnoea index (AI) 53.5 and mean respiratory disturbance index (RDI) 74.2) were investigated. None of the patients had been treated for OSAS prior to the study. The study design was randomized, single-blind, placebo-controlled and cross-over. On the first or second study night, patients were randomly assigned to receive i.v. flumazenil (2 mg) or placebo (0.9% NaCl) between 01:00 and 01:30 h. Comparing the polysomnographic results of the placebo night and the flumazenil night in all 10 patients, no significant differences were found regarding obstructive events or sleep architecture. Accordingly, the data concerning sleep-disordered breathing and sleep stages during the 30 min period prior to and the 30 min period following the administration of flumazenil did not differ. It is concluded that endogenous ligands of the benzodiazepine receptor play no role in the pathogenesis of obstructive sleep apnoea syndrome, since respiratory and sleep data are not altered by flumazenil. Therefore, attempts to treat obstructive sleep apnoea syndrome with flumazenil do not seem to be warranted.

Body Mass Index↗
PubMed1995

[Intermittent self-ventilation. Therapy of chronic respiratory pump fatigue].

Chronic fatigue of the respiratory pump may be due either to constant overexertion of otherwise healthy muscles of respiration (e.g. due to chronic obstructive lung disease, scoliosis) or to certain neuromuscular diseases (e.g. Duchenne type muscular dystrophy). Intermittent self-ventilation (ISV) is employed--in particular at night--in order to prevent imminent exhaustion of the respiratory muscles. The relief provided by ISV gives the muscles a chance to recover. The muscles of respiration can be largely rested by the use of volume-controlled ventilation (IPPV), or partially rested by-BiPAP ventilation (Stimotron). Two main approaches to ventilation are available: non-invasive via a breathing mask or, if this is not possible, invasive ventilation via a tracheostomy. In addition to the commercially available standard nasal masks, we more often make use of custom-made so-called Grafschaft nose-and-mouth masks. The early provision of support for the muscles of respiration can obviate, or at least delay, the need for emergency intubation and subsequent assisted ventilation in an icu in endangered patients.

Equipment Design↗
PubMed1995

[Ventilator weaning after long-term ventilation--the concept of a regional ventilator weaning center].

Long-term mechanical ventilation implies a significant number of weaning failures. The basis of this unweanability is chronic fatigue of the inspiratory muscles which is due to depletion of energy store (e.g. glycogen). Considering this pathophysiological principle, the decisive therapeutic option during weaning from long-term mechanical ventilation consists of resting the respiratory muscles. The commonly used assisted ventilation modes only partially relieve the respiratory muscles because the work of breathing is done both during the trigger phase and during the inspiratory cycle. The essential characteristic of our weaning concept includes the repeated determination of the spontaneous breathing frequency in awake patients, which is followed by controlled intermittent positive pressure ventilation with a slightly higher respiratory rate. Ideally, this results in total suppression of the activity of the breathing centre, and in subsequent relief and recovery of the respiratory muscles by replenishing the energy stores. The close succession of relief and training periods avoids inactivity-induced atrophy of the respiratory muscles and permits regeneration. Additionally, our weaning concept avoids increases in inspiratory work during the phases of spontaneous breathing. This means that high-resistance small-caliber endotracheal tubes have to be replaced by large tubes. Moreover, transtracheal oxygen insufflation during spontaneous breathing decreases anatomic dead space. This reduces minute ventilation and, therefore, the work of breathing. In patients still exhibiting chronic fatigue of the respiratory muscle pump after successful weaning, intermittent home ventilation is initiated via a breathing mask. Apart from the concept described above, successful weaning from the respirator after long-term ventilation is based upon dedicated patient care and depends on the architectural characteristics of the intensive care unit.

Breathing Exercises↗
PubMed1995

[Increase in hypercapnia in exercise--an unloading strategy?].

BACKGROUND: Chronic hypercapnia seems to preserve the overloaded respiratory pump from manifest muscle failure. In order to get information about the regulation of the ventilation under exercise we investigated clinical stable hypercapnic patients. PATIENTS AND METHODS: Twenty-one patients (20 males, 53.7 +/- 13.2 years) with obesity-hypoventilation syndrome (8), chronic obstructive lung disease (4), scoliosis (3), myopathy (2) and post-Tbc (2) were examined. Ventilation parameters (fb, Vt, VO2), respiratory muscle strength (PImax, PEmax), arterial blood gases (pO2, pCO2), respiratory quotient (RQ) and lactate were measured at rest and at the end of 5 minutes of maximal bicycle exercise. The control group consisted of 10 healthy persons. RESULTS AND CONCLUSIONS: A significant augmentation of the pre-existing hypercapnia under exercise (reflecting hypoventilation in relation to the predicted value) was observed in all patients with chronically overloaded respiratory muscles. This mechanism seems to be wise because it protects the respiratory pump from failure.

Adult↗
PubMed1995

[Value of transtracheal oxygen insufflation in the weaning period after long-term ventilation].

BACKGROUND: In many cases, respiratory muscle failure is the reason for unsuccessful weaning attempts after long-term ventilation. Therapeutic measures must therefore be aimed at unloading the respiratory pump. In this present study we examined whether, in particular, the transtracheal O2-insufflation (TTO2) results in a change of breathing patterns and unloads the respiratory muscles. PATIENTS AND METHODS: We examined 6 patients (5 males, age 65.6 +/- 3.9 years, diagnosis: chronic obstructive lung disease), who received long-term mechanical ventilation in outward intensive care units. Baseline resting data (arterial blood gas analysis, the breathing frequency and the minute volume) were obtained with the patients breathing room air for 1 hour. After receiving TTO2 with a flow of 21/min for another 1-hour-period the measurements were repeated. RESULTS AND CONCLUSION: In our study we could show that the TTO2 leads to an impressive decrease in inspiratory work of breathing-relative to the minute ventilation by about 28%. Therefore TTO2 is of great importance in the weaning phase subsequent to prolonged mechanical ventilation due to the respiratory muscle failure.

Aged↗