Biomedical subjects

Frank Mielck

Publications and source records attributed to Frank Mielck.

3 recordsLinked to original sources

PubMed2005

Extracorporeal membrane oxygenation.

PURPOSE OF REVIEW: Extracorporeal membrane oxygenation (ECMO) has become a more or less accepted standard in the algorithm of advanced acute respiratory distress syndrome therapy in adult patients when all other treatment options have failed. This article reviews the current status of ECMO therapy with particular focus on new technical developments and their potential implications for performance and indications for ECMO therapy. RECENT FINDINGS: A recently published review on a single-center experience in 255 adult ECMO patients identified using multivariate logistic regression analysis age, sex, initial pH 7.10 or lower and PaO2/FiO2 ratio, and days of mechanical ventilation before ECMO as a significant predictors of survival. Additionally, a careful cost-effectiveness study for neonatal ECMO relating a 4-year base to the UK neonatal ECMO trial has clearly demonstrated cost-effectiveness. SUMMARY: Over the years, the technique for ECMO therapy underwent substantial changes in indications and the materials used. Impressive technical progress has been made in pumps, oxygenators, and coating of artificial surfaces, leading to a higher biocompatibility and to a lower rate of procedure-related complications. The potential of new inline pumps in combination with a decreasing rate of procedure-related complications might lead to a re-evaluation of the role of extracorporeal lung support in acute respiratory distress syndrome therapy. A very recent development is the use of spontaneous arteriovenous devices for carbon dioxide removal, allowing significant reduction of ventilator settings at decreased carbon dioxide partial pressures and at increased pH values. Ongoing studies are looking at the potential of this approach to reduce side effects of mechanical ventilation further.

Adult↗

PubMed2003

Comparison of continuous cardiac output measurements in patients after cardiac surgery.

OBJECTIVE: To investigate in a direct comparison accuracy and precision of continuous cardiac output measurements assessed by continuous pulmonary artery thermodilution technique (TDCCO), continuous pulse contour analysis (PCCO), and noninvasive partial CO(2)-rebreathing technique (NICO) in patients after coronary artery bypass grafting (CABG) during the postoperative period. DESIGN: Prospective, controlled clinical study. SETTING: University hospital. PARTICIPANTS: Twenty-two patients undergoing elective CABG surgery. INTERVENTIONS: Hemodynamic measurements were performed after admission to the ICU and in sequence every 2 hours during the subsequent 6-hour period. Simultaneously, cardiac output (CO) was measured using a TDCCO, PCCO, and NICO. After the continuous cardiac output measurements were read, bolus thermodilution-derived cardiac output was obtained from thermodilution curves detected in the pulmonary artery (TDBCO(pa)). Four intermittent consecutive boli consisting of 10 mL of ice-cold saline were randomly injected over the ventilatory cycle. MEASUREMENTS AND MAIN RESULTS: The comparison between the continuous cardiac output measurement methods TDCCO versus PCCO showed a bias of -0.12 L/min, between TDCCO versus NICO -0.17 L/min, and between PCCO versus NICO -0.44 L/min. The comparison to the reference technique between TDBCO(pa) versus TDCCO revealed a bias of -0.28 L/min, between TDBCO(pa) versus PCCO -0.40 L/min, and between TDBCO(pa) versus NICO -0.64 L/min. CONCLUSIONS: The results of this clinical investigation show agreement between TDCCO and PCCO to satisfy clinical requirements in a setting of postoperative patients after cardiac surgery. In contrast, the NICO monitor is of very limited use in these patients.

Aged↗

PubMed2002

Methylene blue administration in severe systemic inflammatory response syndrome (SIRS) after thoracic surgery.

A 66-year-old male patient developed significant pleural effusion on the right side six years after coronary bypass grafting and mitral valve replacement. After pleurocentesis, hemo-pneumothorax developed and finally resulted in complete atelectasis of the right lung. Three weeks later, the patient was transferred to our department, and underwent a right lateral thoracotomy. The hematoma was removed and a complete decortication was performed. Four hours postoperatively the patient developed severe SIRS with beginning multiorgan failure. Even extremely high doses of norepinephrine could not raise the systemic vascular resistance. Single intravenous administration of methylene blue lead to significant and permanent improvement of the hemodynamic status.

Aged↗