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Biomedical subjects

H A Bruining

Publications and source records attributed to H A Bruining.

At least 91 records · Page 5Linked to original sources
PubMed1997

An analysis of upper GI endoscopy done for patients in surgical intensive care: high incidence of, and morbidity from reflux oesophagitis.

OBJECTIVE: To investigate the role of upper gastrointestinal (GI) endoscopy in a surgical intensive care unit [ICU]. DESIGN: Retrospective analysis. SETTING: University hospital, The Netherlands. SUBJECTS: 87 Male and 42 female patients, mean age 62.0 years (range 14-86). INTERVENTIONS: 198 Upper GI endoscopies. MAIN OUTCOME MEASURES: Incidence of, indication for, and abnormalities noted at upper GI endoscopy. RESULTS: 52 (40%) and 18 (14%) patients underwent 82 and 27 upper GI endoscopies, respectively, for evaluation of upper GI haemorrhage and surgical anastomoses. 59 Patients (46%) underwent 89 endoscopies for placement of nasoduodenal feeding tubes (n = 86, 97%), biliary stents (n = 2, 2%) and gastrostomy cathether (n = 1, 1%). The causes of haemorrhage were: oesophagitis (n = 13, 25%), duodenal ulcer (n = 13, 25%), gastric ulcer (n = 7, 13%) and others (n = 14, 28%). In 6 cases (11%), no bleeding site was detected. As a coincidental finding, a third of all patients had oesophagitis. The incidence of haemorrhage in patients treated and not treated by mechanical ventilation was 43/1350 (3.2%) and 9/1470 (0.6%), respectively (p < 0.0001). CONCLUSIONS: Upper GI endoscopy is a common diagnostic and therapeutic procedure in a surgical ICU. Reflux oesphagitis is often found and is clinically important. Mechanical ventilation is a risk factor for upper GI haemorrhage.

Critical Care↗
PubMed1996

Clinical evaluation of diminished early expiratory flow (DEEF) ventilation in mechanically ventilated COPD patients.

OBJECTIVE: To evaluate the cardiopulmonary effects, especially the end-expiratory lung volume (EEV) and ventilation inhomogeneity during diminished early expiratory flow ventilation (DEEF), which resembles pursed-lips breathing, with the conventional intermittent positive pressure ventilation (IPPV) in postoperative mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). DESIGN: A prospective study measuring cardiopulmonary parameters during IPPV, DEEF, and positive end-expiratory pressure (PEEP) as a control mode. In the PEEP mode, PEEP values were chosen such that the mean airway pressure during a breath cycle was equal to that during the DEEF mode, which was higher than the conventional IPPV mode. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: 20 postoperative mechanically ventilated COPD patients who were optimally pretreated and had normal blood oxygenation. INTERVENTIONS: Measurements were started in the IPPV (IPPV1) mode, continued in a randomized order with DEEF or PEEP, and completed with a second IPPV (IPPV2) mode, with 1 h equilibration time in each mode before each measurement. MEASUREMENTS AND RESULTS: A multi-breath indicator gas wash-out test was used to calculate the EEV and ventilation inhomogeneity. There was a 9% increase (p < 0.05) in the mean EEV during both the DEEF and PEEP mode compared to IPPV. No significant changes in the ventilation inhomogeneity and deadspace fractions or the hemodynamic parameters were found during the different ventilatory modes. CONCLUSIONS: There was no improvement in pulmonary and hemodynamic parameters during the DEEF mode in comparison to the IPPV mode. The small increase in EEV during DEEF was probably caused by the slightly higher mean expiratory pressures as in the PEEP mode. However, this had no effect on the hemodynamic parameters. As we could not observe any improvement with the DEEF ventilation in our optimally pretreated postoperative COPD patients, we do not advise applying this therapy in this group of patients, since this mode of ventilation may cause barotrauma if not monitored adequately.

Aged↗
PubMed1996

Pressure sores in an intensive care unit and related variables: a descriptive study.

The development of pressure sores is associated with negative patient outcome. Patients in an intensive care unit (ICU) are particularly prone to developing pressure sores, caused by severe illness and being immobile for long periods. A method to prevent the development of pressure sores is to use the Waterlow pressure sore risk calculator as a warning device, followed by appropriate action. A prevalence study on pressure sores was conducted in the ICU, where the following variables were noted for each patient admitted: pressure sore stage on sacrum or buttocks, the Waterlow pressure sore risk score, and the number and kind of preventive measures taken by the nursing staff. The results show that the prevalence of pressure sores varies greatly over the study period, that a relationship exists between the pressure sore stage and the risk of developing a pressure sore and that nurses are more motivated to take pressure sore precautions based on the visible damage due to pressure than by the warning provided by the presence of specific risk factors. It is concluded that point prevalence measurement does not give reliable information about the pressure sore problem in general in an ICU and that daily measurement of the risk of developing pressure sores with the Waterlow pressure sore risk calculator helps nurses to indicate specific risk factors and assists them with decisions on the frequency and method of pressure sore precautions to be taken.

Adolescent↗
PubMed1996

The use of somatostatin receptor scintigraphy in the differential diagnosis of pancreatic duct cancers and islet cell tumors.

OBJECTIVE: In the present study, the diagnostic value of somatostatin receptor scintigraphy (SRS) was evaluated in the preoperative workup in patients with pancreatic duct cancers and islet cell tumors, as well as in the follow-up of these patients. METHODS: Twenty-six patients with suspected primary pancreatic duct cancers and 48 patients with islet cell tumors were studied. The SRS was performed using the radionuclide-labeled somatostatin analogue 111In-octreotide. Another group of 12 patients who were still alive more than 3 years after pancreaticoduodenectomy for pancreatic duct adenocarcinomas also underwent SRS. RESULTS: In 31 (65%) of 48 patients, the primary pancreatic islet cell tumor as well as its often previously not yet recognized metastases could be visualized. In contrast, none of the 26 pancreatic adenocarcinomas or their metastases could be seen. In 5 of 12 patients who were alive more than 3 years after pancreaticoduodenectomy for pancreatic duct adenocarcinomas, metastatic lesions were visualized at SRS. In retrospect, these patients were not operated on for adenocarcinomas but for "nonfunctioning" islet cell tumors. CONCLUSIONS: The present study supports the concept that SRS has a place in the preoperative differential diagnosis of islet cell tumors and pancreatic duct cancers as well as in the follow-up, especially in those cases in which no tumor histologic analysis was obtained, or the pathologic examination of the tumor tissue had not included special staining procedures for neuroendocrine characteristics. Our results also indicate that the evaluation of the results of investigations on the role of surgery or radiation therapy and chemotherapy or both in pancreatic duct cancer have to be interpreted with caution, if no histologic analysis and staining for neuroendocrine characteristics was performed.

Adenocarcinoma↗
PubMed1996

Patient-to-patient spread of a single strain of Corynebacterium striatum causing infections in a surgical intensive care unit.

Over a 12-month period, Corynebacterium striatum strains were isolated from clinical specimens from 14 patients admitted to a surgical intensive care unit. These isolates were identical by morphology and biotype and displayed the same antibiogram. Ten isolates were found to be the sole possible pathogen. These 10 isolates were from six patients, three of whom had signs of infection at the time of positive culture. Further typing was performed by random amplification of polymorphic DNA analysis, by which all strains were identical and were found to differ to various degrees from reference strains and from isolates found in clinical samples from other wards. In a case-control study the only independent risk factor for acquiring the strain was intubation for longer than 24 h (odds ratio, 20.09; 95% confidence interval, 2.29 to 176.09). The same strain was isolated from surfaces and from air sampled in the direct vicinity of infected patients but never from surfaces or air in other places of the ward. The strain was not isolated from the ventilators. The strain was cultured from the hands of personnel attending to infected patients, but no long-term carriers were found among members of the hospital personnel, suggesting transient carriage only. We conclude that C. striatum can cause serious nosocomial infections in surgical intensive care unit patients and may spread from patient to patient via the hands of attending personnel.

Corynebacterium↗
PubMed1995

An experimental set-up to test heat-moisture exchangers.

OBJECTIVES: The purpose of this study was to build an experimental set-up to assess continuously the humidification, heating and resistance properties of heat-moisture exchangers (HMEs) under clinical conditions. DESIGN: The experimental set-up consists of a patient model, measurement systems and a ventilator. SETTING: Surgical ICU, University Hospital of Rotterdam. MATERIALS: A clinically used HME. MEASUREMENTS AND RESULTS: The air flow, pressure in the ventilation circuit, pressure difference over the HME, and partial water vapour pressure and temperature at each side of the HME were measured. The resistance, absolute humidity, humidification efficiency and temperature difference at the patient side of the HME were calculated. Measurements were performed during 24 h. The temperature output, humidity output and lung mechanics of the patient model were similar to values found in mechanically ventilated patients. The measurement system was in agreement with the ISO draft standard and was capable of measuring dynamic variation of water and heat exchange over the range of a clinically used ventilator setting. CONCLUSION: The experimental set-up described is reliable for evaluating HMEs and can also be used for future clinical evaluation of HMEs. The main advantages of this set-up over those described previously are: (i) measurements of dynamic variations of water and heat exchange; (ii) on-line measurements of expiratory, as well as inspiratory resistance.

Analysis of Variance↗
PubMed1995

Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis.

OBJECTIVE: A randomized, controlled, multicenter trial was undertaken in 102 patients with objective evidence of severe acute pancreatitis to evaluate whether selective decontamination reduces mortality. SUMMARY BACKGROUND DATA: Secondary pancreatic infection is the major cause of death in patients with acute necrotizing pancreatitis. Controlled clinical trials to study the effect of selective decontamination in such patients are not available. METHODS: Between April 22, 1990 and April 19, 1993, 102 patients with severe acute pancreatitis were admitted to 16 participating hospitals. Patients were entered into the study if severe acute pancreatitis was indicated, on admission, by multiple laboratory criteria (Imrie score > or = 3) and/or computed tomography criteria (Balthazar grade D or E). Patients were randomly assigned to receive standard treatment (control group) or standard treatment plus selective decontamination (norfloxacin, colistin, amphotericin; selective decontamination group). All patients received full supportive treatment, and surveillance cultures were taken in both groups. RESULTS: Fifty patients were assigned to the selective decontamination group and 52 were assigned to the control group. There were 18 deaths in the control group (35%), compared with 11 deaths (22%) in the selective decontamination group (adjusted for Imrie score and Balthazar grade: p = 0.048). This difference was mainly caused by a reduction of late mortality (> 2 weeks) due to significant reduction of gram-negative pancreatic infection (p = 0.003). The average number of laparotomies per patient was reduced in patients treated with selective decontamination (p < 0.05). Failure of selective decontamination to prevent secondary gram-negative pancreatic infection with subsequent death was seen in only three patients (6%) and transient gram-negative pancreatic infection was seen in one (2%). In both groups of patients, all gram-negative aerobic pancreatic infection was preceded by colonization of the digestive tract by the same bacteria. CONCLUSION: Reduction of gram-negative colonization of the digestive tract, preventing subsequent pancreatic infection by means of selective decontamination, significantly reduces morbidity and mortality in patients with severe acute necrotizing pancreatitis.

Acute Disease↗
PubMed1995

Temperature-induced down-regulation of the glucocorticoid receptor in peripheral blood mononuclear leucocyte in patients with sepsis or septic shock.

OBJECTIVE: Activation of the hypothalamic-pituitary-adrenal axis is of vital importance during critical illness. We have studied the adaptive mechanisms which occur at the level of the glucocorticoid receptor in glucocorticoid target tissues in patients with sepsis or septic shock. DESIGN: The effects of hypercortisolaemia, hyperthermia and cellular composition on number of glucocorticoid receptors per cell and their affinity were evaluated, both in vitro and in vivo, in peripheral blood mononuclear leucocytes of control subjects and in patients with sepsis or septic shock. SUBJECTS: Fifteen patients (age 25-79) with sepsis or septic shock who were admitted to an intensive care unit were studied. The control group consisted of 24 healthy laboratory employees. MEASUREMENTS: The binding capacity and affinity of the glucocorticoid receptors were measured and compared to clinical data and the plasma cortisol concentrations. RESULTS: Hypercortisolaemia, in vitro, resulted in a decreased affinity and a decreased binding capacity of the glucocorticoid receptor. In vitro, hyperthermia as well as variations in the cellular composition did not influence the glucocorticoid receptor. In vivo, there was no change in the number of receptors per cell in patients with sepsis or septic shock as compared to healthy controls. However, a decreased affinity of the glucocorticoid receptor was observed. There was a weak but significant negative correlation between body temperature and the number of glucocorticoid receptors in the patient group. There was no relation between circulating cortisol concentrations and glucocorticoid receptor affinity and number. CONCLUSIONS: There is no obvious regulation of the number of glucocorticoid receptors by plasma cortisol concentrations in vivo. The decreased affinity of the glucocorticoid receptor together with the negative correlation between hyperthermia and the number of glucocorticoid receptors in patients with sepsis or septic shock suggest that hypothalamic-pituitary-adrenal axis activation during critical illness is accompanied by peripheral adaptation in glucocorticoid receptor number and affinity.

Adult↗
PubMed1995

Increase of cardiac work is associated with decrease of mitochondrial NADH.

In this study we investigated the effect of work and substrate supply on mitochondrial NADH/NAD+ using epicardial autofluorescence in rat hearts perfused according to Langendorff. To avoid vasoconstrictor effects during high work output, nitroprusside-containing Tyrode solution was used. Photobleaching was avoided by using discontinuous ultraviolet excitation for NADH fluorescence measurements. To increase work, heartbeat rate was raised from 5 to 7 Hz, and concomitantly left ventricular pressure was raised stepwise from 0 to +/- 90 mmHg. During substrate-limited (5.5 mM glucose) perfusions, increase in O2 consumption (3.5 +/- 0.4 mumol.min-1.g-1, mean +/- SE, n = 6) caused by increase of heartbeat rate was associated with a significant decrease of NADH fluorescence (-31 +/- 2.5%, mean +/- SE, n = 6). During perfusions with 10 mM pyruvate increase of O2 consumption (3.6 +/- 0.7 mumol.min-1.g-1, mean +/- SE, n = 6) was associated with significant decrease of NADH fluorescence (-20 +/- 2.6%, mean +/- SE, n = 6). These results suggest that a rise in mitochondrial NADH/NAD+ is not the primary stimulus for increase in respiration and that changes of mitochondrial NADH/NAD+ are secondary to changes in O2 consumption.

Animals↗
PubMed1995

Acute dialytic support for the critically ill: intermittent hemodialysis versus continuous arteriovenous hemodiafiltration.

There is still debate about whether continuous renal replacement therapy is superior to intermittent hemodialysis (IHD) as dialytic support for the critically ill patient with acute renal failure, mainly because of lack of comparative data. We sought to address this issue by reviewing the medical records of such patients admitted to a single surgical intensive care unit treated with either continuous arteriovenous hemodiafiltration (CAVHD) or IHD between January 1, 1986, and August 31, 1993. Of 94 consecutive patients who received dialytic support for severe acute renal failure, 34 (36%) patients were treated with IHD and 60 (64%) patients with CAVHD. The patients were comparable in terms of age or gender and represented a similar case mix. Patients treated with CAVHD were more severely ill as manifested by a lower mean arterial pressure (75 +/- 3 vs. 86 +/- 5 mm Hg; p < 0.05), higher Apache II score (26.5 +/- 0.5 vs. 22.2 +/- 0.3; p < 0.05), and a higher number of organ system failures (3.4 +/ 0.2 vs. 2.6 +/- 0.3; p < 0.05). Despite greater illness severity and a higher probability of death (55 +/- 2.6 vs. 33 +/- 2.5%; p < 0.0001), in those treated with CAVHD, no difference in outcome was observed between groups: CAVHD 26/60 (43%) vs. IHD 20/34 (59%; NS). The mean Apache II score of patients treated with CAVHD who survived was similar to that of patients treated with IHD who died (24.5 +/- 0.3 vs. 24.2 +/- 0.4; NS).(ABSTRACT TRUNCATED AT 250 WORDS)

APACHE↗
PubMed1995

High-risk surgical acute renal failure treated by continuous arteriovenous hemodiafiltration: metabolic control and outcome in sixty patients.

The outcome and metabolic control was studied in 60 critically ill patients with acute renal failure (ARF) treated by continuous arteriovenous hemodiafiltration (CAVHD) in a single surgical intensive care unit. Mean age (+/- SEM) was 60 +/- 2 years with a male predominance (80%). The majority of patients required mechanical ventilation (83%) and/or vasopressor support (70%) and suffered from multiorgan failure [mean number of organ system failures 3.3 +/- 0.3 (range 1-6)]. CAVHD resulted in a rapid decline of serum urea and creatinine levels during the first 72 h (urea 47.4 +/- 2.3 to 30.3 +/- 1.4 mmol/l, p < 0.05, and creatinine 572 +/- 27 to 361 +/- 23 mumol/l, p < 0.05); thereafter, controlled steady-state levels were achieved with serum urea levels kept below 30 mmol/l with full protein alimentation and often despite hypotension, surgery and septicemia. Significant electrolyte derangements could be easily corrected and maintained within normal limits. Bicarbonate homeostasis could be restored within 48 h in patients with severe metabolic acidosis (HCO3- < 20 mmol/l) with use of bicarbonate as a buffering anion (17 +/- 0.5 to 23.2 +/- 0.6, p < 0.05). CAVHD allowed rapid removal of excess body and lung water (up to 5 liters/day) without hemodynamic instability. Despite a mean pretreatment APACHE II score of 26.5, 26 patients (43%) survived until discharge from the intensive care unit, of whom 23 (38%) survived to leave hospital. Requirement of mechanical ventilation or vasopressor support, higher APACHE II scores and septicemia were all associated with a poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

APACHE↗