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Biomedical subjects

E F Klein

Publications and source records attributed to E F Klein.

17 recordsLinked to original sources
PubMed1989

Accurate determination of end-tidal carbon dioxide during administration of oxygen by nasal cannulae.

Measurement of end-tidal carbon dioxide tension (PETCO2) by mass spectrometry or infrared capnometry provides a clinically useful approximation of arterial carbon dioxide tension (PaCO2) in intubated patients. Although several devices have been proposed to sample PETCO2 during spontaneous breathing (i.e., unintubated patients receiving supplemental oxygen), thus far no reports have documented their efficacy. This article reports the use of an easily constructed modification of simple nasal cannulae that permits accurate sampling of PETCO2 during oxygen administration to unintubated patients. After amputation of the closed tip, a cap from a syringe was inserted via a slit made at the base into one prong of a pair of nasal cannulae. A capnometer was connected to the syringe cap, and PETCO2 and PaCO2 were determined simultaneously during the administration of 3 L/min oxygen via nasal cannulae to 21 normocapnic patients. The PaCO2 - PETCO2 gradients were calculated and compared with values obtained in the same patients after intubation and mechanical ventilation. No significant difference was found between the calculated gradients with nasal cannulae (2.09 +/- 2.18 mm Hg) versus intubation (2.87 +/- 2.82 mm Hg). Simultaneous oxygen administration and accurate sampling of PETCO2 may be achieved in unintubated patients by using this easily constructed modification of nasal cannulae.

Adult↗
PubMed1986

Cardiopulmonary effects of severe thoracic subcutaneous emphysema.

Isolated subcutaneous emphysema appeared to cause significant pulmonary dysfunction in a traumatized child with no demonstrable intrinsic pulmonary injury or disease. We developed an animal model of severe thoracic subcutaneous emphysema to determine whether it alters pulmonary-thoracic compliance such that ventilation-perfusion relationships or cardiac performance are affected adversely. Twelve anesthetized, mechanically ventilated swine were studied. Baseline measurements and calculations included intrapulmonary shunt fraction (Qsp/Qt), total static pulmonary-thoracic compliance, thermodilution cardiac output, systemic and pulmonary arterial pressures, and mean pulmonary arterial occlusion pressure. Measurements and calculations were repeated after each of three consecutive injections of 400 cc of air into the tissue over the sternum. Comparison of the baseline values with those after the injections showed no increase in Qsp/Qt and no change in any other variable (p less than 0.05). We conclude that, in this model, isolated thoracic subcutaneous emphysema does not adversely affect cardiopulmonary function during positive pressure ventilation.

Animals↗
PubMed1975

Weaning from mechanical breathing with intermittent mandatory ventilation.

Intermittent mandatory ventilation allows a gradual transition from mechanical ventilation to spontaneous breathing. This is accomplished by providing a continuous source of fresh gas from which the patient can breathe as ventilator rates are decreased from 1 to 2 per minute. Monitoring of arterial blood gas tension values documents the safety of further withdrawal of ventilatory support. Many patients are more easily and safely weaned by this method than by conventional techniques.

Acid-Base Equilibrium↗
PubMed1975

Treatment of flail chest. Use of intermittent mandatory ventilation and positive end-expiratory pressure.

For the past two years we have treated patients with flail chest injuries and concomitant respiratory failure with intermittent mandatory ventilation (IMV) and positive end-expiratory pressure (PEEP). Prior to 1972 these patients were treated with controlled mechanical ventilation (CMV) until gross flailing ceased and inspiratory force and vital capacity measurements were adequate. We retrospectively studied the charts of 37 consecutive patients to compare the length of mechanical ventilatory support of patients managed by conventional CMV with those ventilated with IMV and PEEP. The mean ventilation time of patients treated with IMV and PEEP (5.1 +/- 4.7 days) was significantly less than that of the patients treated with CMV (18.8 +/- 14.4 days) (P less than .001).

Accidents, Traffic↗
PubMed1975

High level positive end expiratory pressure (PEEP) in acute respiratory insufficiency.

Twenty-eight patients developed severe, progressive acute respiratory insufficiency despite aggressive application of conventional respiratory therapy. Application of increased PEEP (18 torr or greater) resulted in a significant decrease in QA/QT. Selection of the optimal levle of PEEP for each patient required serial determinations of QA/QT and measurement of cardiovascular response. The overall survival rate was 61 percent. Acute respiratory insufficiency was a proximate cause of death in only one patient. Four of the patients (14 percent) developed a pneumothorax following institution of high PEEP therapy. Cardiac output was not affected adversely at any level of PEEP up to 32 torr (44 cm H2O). We conclude that high levels of PEEP can be therapeutic for patients with refractory respiratory failure when combined with intermittent mandatory ventilation and careful cardiovascular monitoring. As with any therapy, the optimum dose should be tailored to each patient according to his needs and response.

Acute Disease↗