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Biomedical subjects

G Laier-Groeneveld

Publications and source records attributed to G Laier-Groeneveld.

At least 19 recordsLinked to original sources
PubMed2004

[Multicenter study on "non-invasive ventilation in patients with severe chronic obstructive pulmonary disease and emphysema(COPD)"].

Non-invasive ventilation is applied with increasing frequency in patients with chronic hypercapnic COPD and insufficiency of the ventilatory pump. In the few existing clinical trials on long-term use of NIV, no significant improvement on survival could be proven, mainly due to methodical reasons. The "National Task Force for Non-invasive ventilation and weaning" plans to study patients with severe COPD and hypercapnic ventilatory pump insufficiency in a prospective, randomised, multicentre clinical trial over one year. In the intervention group, NIV will be applied for at least six hours per day in addition to standard COPD-treatment. The target of mechanical ventilation is a reduction of PCO (2) during spontaneous breathing by at least 20 %, or into the normal range. The main outcome parameter is all-cause mortality, secondary outcome parameters are course of the disease, exercise capacity, quality of life and consumption of medical resources. The sample size is estimated on 300 patients (150 control group, 150 intervention group). The whole study will take approximately three years.

Emphysema↗
PubMed2002

Infrastructure, funding and follow-up in a programme of noninvasive ventilation.

Originating from centres charged with the care of patients with chronic respiratory insufficiency, noninvasive ventilation (NIV) has been used increasingly in chronic and acute respiratory failure during the last decade. Despite a considerable number of series and randomised studies advocating access to NIV for units that treat acute or chronic ventilatory failure, the number of units and the proportion of total ventilatory support remains poor. This is due to lack of education, as many units treat only a few patients per year. Indication, technique, education, monitoring and home care require special experience and a special environment and there is a wide range throughout Europe. With respect to home care in particular, there are many organisations, which range from totally private to hospital based or run for profit. A concerted action, funded by the European Union, will soon provide valuable information about the practice of home ventilation in Europe based on a European survey.

European Union↗
PubMed2002

Biochemical markers of cerebrovascular injury in sleep apnoea syndrome.

Sleep apnoea syndrome (SAS) is a known risk factor for vascular diseases and stroke. Structural brain damage, manifesting as an overt neurological deficit or more subtly as cognitive dysfunction, is a frequent symptom in SAS. The presence of a biochemical marker of cerebral injury would be of great benefit in SAS to screen for even small brain damage and to monitor efficiacy of therapy. Therefore, in 10 patients with mild SAS (age 50.8+/-9.9 yrs, respiratory disturbance index (RDI) 18+/-3.6, lowest arterial oxygen saturation (min Sa,O2) 80.5+/-4.06%) and nine patients with severe SAS (age 50.3+/-11.5 yrs, RDI 75.4+/-21.7, min Sa,O2 56.56+/-14.58%), serum concentrations of neuron-specific enolase (NSE), S-100beta protein, and beta-trace were measured just before and after sleep using commercially available assays. Only serum levels in the normal range could be found, independent of when the blood was taken or the degree of SAS. Structural cerebral injury caused by sleep apnoea syndrome in patients without neurological symptoms or previous cerebrovascular events may be too small to produce a measurable increase in S-100beta, neuron-specific enolase and beta-trace serum concentrations or subclinical cerebral damage may be outside the lower detection limits of the analytical methods which were used. There is a need for biochemical markers and more sensitive methods for detecting small cerebral injury in sleep apnoea syndrome.

Adult↗
PubMed1999

[Nasal mechanical ventilation in children].

BACKGROUND: Nasal mechanical ventilation is not only applicable to adults but also in childhood when necessary. PATIENTS AND METHODS: Thirty-six children suffering from various neuromuscular diseases were brought up by their parents to learn nasal mechanical ventilation. Thirty children had to be ventilated, because of symptomatic ventilatory failure, reduced ventilatory muscle capacity or hypercapnia. RESULTS: Thirty-five children could be adapted to nasal mechanical ventilation, 1 girl needed a naso-oral mask. All children wanted to continue with ventilation because they realized the benefit. Their symptoms disappeared. CONCLUSIONS: The management of ventilatory failure should be the same in adults and children. Nasal mechanical ventilation is indeed a good possibility for children even in early childhood. Children should be introduced to mechanical ventilation at the beginning of the symptoms of ventilatory failure.

Adolescent↗
PubMed1999

[The role of non-invasive positive pressure ventilation in lung volume reduction surgery of pulmonary emphysema--a survey of German hospitals].

BACKGROUND: Since the first publication by Cooper et. al. in 1994 of lung volume reduction surgery (LVRS) of emphysema a marked respiratory failure with hyperkapnia (PaCO2 > 55 Torr) has been regarded as an exclusion criterion for LVRS. PATIENTS AND METHOD: In a survey in German hospitals the question was asked whether non-invasive nasal ventilation (NIPPV) has a role in the management of LVRS. Of 12 hospitals 6 had experience with NIPPV and LVRS in a total of 19 patients with a mean FEV1 of 0.64 +/- 0.101. RESULTS: LVRS improved FEV1 by 0.20 +/- 0.181. Preoperative NIPPV was short (< 6 months) in 8 patients and resulted in improvement of physical condition and getting the patient used to NIPPV for better perioperative management. In 5 cases NIPPV was used on a long-term basis in order to allow the patient to be included in the LVRS program. In fact 7 of these 13 patients needed ventilation perioperatively, and 4 had to continue long-term NIPPV after surgery. In further 3 patients NIPPV was applied only perioperatively. One patient had to resume NIPPV after 15 months. Two patients started NIPPV 1 resp. 12 months after surgery. Two patients had bronchial cancer which was resected. Four patients died: 1 perioperatively after intubation, 2 after 3 resp. 13 months due to respiratory failure, 1 for cancer relapse after 20 months. CONCLUSION: NIPPV may be helpful in the planning and management of LVRS in patients with ventilatory failure with hypercarbia.

Female↗
PubMed1999

[Amyotrophic lateral sclerosis and nasal mechanical ventilation].

BACKGROUND: Patients suffering from amyotrophic lateral sclerosis (ALS) can profit from nasal mechanical ventilation and improve in the quality of life. PATIENTS AND METHODS: Thirty-eight patients were introduced to nasal mechanical ventilation, using pressure- and volume-cycled respirators. The daily periods of mechanical ventilation varied from 8 to 24 hours. RESULTS: Twelve women and 26 men with ALS mostly with severe symptoms were adapted to the intermittent nasal ventilation. 80% had bulbar symptoms. Nineteen patients died till now. Even when complications occurred it was possible to use the noninvasive ventilation. CONCLUSIONS: Noninvasive mechanical ventilation is possible in spite of complications and improves the quality of life in ALS.

Adult↗
PubMed1999

[Fitness training during nasal ventilation in diseases limited by dyspnea].

METHODS: Five patients with chronic ventilatory failure demonstrated by arterial hyperkapnia and overloaded respiratory muscles under spontaneous ventilation (P01/P01 max) were adapted to passive noninvasive ventilation (ISB). Three of them suffered from severe COPD (FEV1 < 50%), two patients from severe restriction (VC < 30%). These patients had to undergo a bicycle ergometer exercise with and without nasal ventilation until they reached physical exhaustion with standardised incremental increase in external workload. RESULTS: In both settings all patients were able to manage exercise up to their physical exhaustion. The anaerobic limit was exceeded each time. The total ventilation volume had to be increased two- to threefold during exercise with nasal ventilation to maintain the passive ventilation. The reduced load on the respiratory muscles was generally proven by lower pCO2 and higher pH levels. Without ventilation discontinuation of the exercise was caused by dyspnoea, whereas this was due to weakness in the legs under ventilation. In all five cases the achieved level of external workload was higher when supporting the respiratory muscles (43 watts vs. 36 watts) at lower lactate levels. CONCLUSION: On a bicycle ergometer the respiratory muscles can be sufficiently relieved using noninvasive nasal ventilation. A higher level of workload, longer duration and a higher quality of exercise can be achieved thereby. The fact that patients without relief of load of the respiratory muscles complained of dyspnoea, whereas the fact that patients with ventilation complained of weakness in their legs indicates the high efficiency of this method, although the tested patients are severely handicapped individuals who usually do not undergo comparable physical exercise in their daily activities.

Aged↗
PubMed1997

[Epidemiology and diagnosis of intermittent self-ventilation].

The purpose of the lung is intrapulmonary gas exchange. The circulatory system delivers the respiratory gases to the tissue. The ventilatory pump however is responsible for the circulation of air between the lungs and the ambient atmosphere. Due to better diffusing capabilities, hypercapnia always is a result of pump failure and little dependent on the lung. Ventilatory failure, either compensated with an increased demand on the muscles or decompensated with an additional increase in pCO2, should be separated from lung failure where primarily oxygen exchange is involved. Decompensated hypercapnic ventilatory failure is then the indication for intermittent mechanical ventilation. The pCO2, either arterial or transcutaneously registered together with the noninvasive evaluation of the mouth occlusion pressures during tidal breathing and during a maximal inspiratory effort, define well the severity of ventilatory failure. In acute on chronic ventilatory failure, noninvasive mechanical ventilation in three randomised and controlled studies resulted in a better survival compared to intubation. To fulfil certain weaning criteria is no longer required in difficult to wean patients, as a transfer from invasive to noninvasive mechanical ventilation can be performed if only cooperativity is preserved together with a minimal capacity of spontaneous breathing. Weaning will thereafter occur by progressive relief from intermittent noninvasive ventilation. 2300 difficult to wean patients in Germany should profit from this approach. Chronic ventilatory failure as a result of neuromuscular disease or scoliosis of the thoracic spine are the classical indications. COPD and myasthenia gravis are under discussion as indications for intermittent mechanical ventilation with an increasing tendency to ventilate. Epidemiological data however can only be roughly estimated due to the heterogeneity of indication and selection of the patients.

Cross-Cultural Comparison↗
PubMed1997

[The etiology of chronic hypercapnia].

BACKGROUND: The ventilatory and the pressure response to CO2 in patients with advanced thoracic disorders are critically dependent on the mechanics of the lung and the respiratory muscles. Changes in drive, therefore, can not be directly assessed with that method. However during changes as a result of intermittent mechanical ventilation, changes in drive can be assessed, if lung and muscle mechanics remain unaffected. In addition, to study changes in ventilatory drive independently in patients successfully treated by intermittent mechanical ventilation, we determined the recruitment threshold, pCO2RT, of the unloaded ventilatory pump to CO2. PATIENTS: 16 patients with various disorders (4 COPD, 4 COPD and sleep apnoea, 7 scoliosis, 1 fibrothorax) were studied, 14 during nasal IPPV and 2 during mechanical ventilation via tracheostomy. RESULTS: After they had been successfully adapted to the ventilator, they were entered into the study. The apnoea threshold in all cases had already been reached during the adaptation period. pCO2AT was determined 32 +/- 5 mm Hg. While the patients were passively ventilated, the inspiratory CO2 was increased every 5 minutes, resulting in a stepwise increase in arterial pCO2 by 3 mm Hg. The recruitment threshold pCO2RT was then defined as the lowest pCO2, which resulted in a deformation of the inspiratory pressure curve by the patients own inspiratory efforts. pCO2RT was reproducible within trials and in different trials with a standard error of 1.2 mm Hg. It was found 6 +/- 4 mm Hg above the pCO2 during spontaneous breathing (p < 0.01) in all patients. pCO2RT decreased from 58 +/- 10 to 47 +/- 4 mm Hg during intermittent IPPV and so did the threshold during CO2 rebreathing, while spontaneous pCO2 decreased from 53 +/- 12 to 42 +/- 5 mm Hg. The slope, reflecting drive was decreased to 0.28 compared to normals but remained unchanged 0.32 (n. s.) during the study. Lung function did not change. A highly significant increase in the indices of maximal inspiratory force was observed (p < 0.002) and as a result a decrease in the inspiratory demand (p < 0.008). CONCLUSION: Intermittent IPPV does efficiently suppress phasic respiratory drive via thoracic afferent inhibition and therefore effectively unloads the ventilatory pump. The CO2 threshold is increased in patients with hypercapnic ventilatory failure, probably to minimise the load to the ventilatory muscles. With the increase in inspiratory capacity the pCO2 threshold can be restored to normal by intermittent noninvasive or invasive IPPV.

Adult↗
PubMed1997

[Quality of life in home ventilation].

BACKGROUND: The purpose of this study is to assess quality of life in patients with chronic respiratory failure who require home mechanical ventilation (HMV). PATIENTS AND METHODS: Patients with COPD (n = 20), scoliosis (n = 20), neuromuscular diseases (n = 20) and others (n = 7) were examined. A specific questionnaire containing forms for the patient, the physician and for the relatives was developed according to the formulation of the question (Fragebogen zur chronischen Heimbeatmung = FCH, Interview zur chronischen Heimbeatmung = ICH). In addition to that the Hospital Anxiety and Depression Scale (HAD) and the Asthma Quality of Life Questionnaire were used. Arterial blood gas tensions, pulmonary function and inspiratory mouth occlusion pressure were studied. RESULTS: Quality of life in patients with scoliosis and neuromuscular diseases is improved during HMV compared to patients with COPD who especially are impaired with regard to psychological and functional conditions. Correlations with physiological parameters and with the compliance could not be observed. CONCLUSION: Despite progression of the disease HMV enhances quality of life in patients with scoliosis and neuromuscular diseases. The outcome in COPD is less evident. Therefore the indication must be considered more critically.

Adult↗
PubMed1995

Oxygen cost of breathing for assisted spontaneous breathing modes: investigation into three states of pulmonary function.

OBJECTIVE: We investigated the effects of continuous positive airway pressure (CPAP) and pressure support ventilation (PSV) on the oxygen cost of breathing (VO2resp) for different states of pulmonary function. Additionally VO2resp was measured during spontaneous breathing. DESIGN: This was done in a controlled and prospective study. Ventilatory modes were applied randomly. SETTING: Measurements were performed in a quiet room on volunteers (VOL) and inpatients treated for chronic obstructive pulmonary disease (COPD). Post-operative patients after aortocoronary bypass surgery (ACB) were studied on the cardio-thoracic intensive care unit just before and after extubation. PATIENTS: Healthy volunteers (n = 14), postoperative patients after aorto-coronary bypass surgery (n = 15) and patients with COPD (n = 9, xFEV1 47.7%) were the objects of study. INTERVENTIONS: Demand flow CPAP (5 mbar) and PSV (7 mbar, PEEP 5 mbar), using the Hamilton Veolar ventilator, were investigated in comparison to spontaneous breathing. MEASUREMENTS AND RESULTS: VO2 was measured by a Datex Deltatrac metabolic monitor. VO2resp was calculated by subtraction of total oxygen uptake (VO2tot) in controlled mode ventilation (CMV) from that in the respective spontaneous breathing mode. For VOL and COPD patients who were not intubated, a CPAP facemask connected to a short 7.5 mm tube was used as connection to the ventilator. Breathing spontaneously under a canopy system VOL showed a VO2resp of 4.5 +/- 4.0% compared to 9.2 +/- 3.5% for ACB and 15.4 +/- 7.7% for COPD. CPAP changed the VO2resp to 7.8 +/- 3.9%, 12.0 +/- 4.0% and 9.1 +/- 3.6% respectively. PSV reduced the VO2resp to 7.9 +/- 3.8% in ACB and 7.7 +/- 5.5% in COPD. CONCLUSIONS: This investigation confirms findings that postoperative patients have a mild increase in VO2resp. COPD exhibit the highest increase in VO2resp. Tracheal tubes, masks and CPAP on a demand flow apparatus increases VO2resp in volunteers and postoperative patients after cardiac surgery. The same amount of CPAP in contrary reduces VO2resp in patients with COPD. Pressure support ventilation can offset the additional VO2resp induced by CPAP but at the same level does not further reduce VO2resp in COPD patients.

Adult↗