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H Lennartz

Publications and source records attributed to H Lennartz.

At least 37 records · Page 2Linked to original sources
PubMed1990

Extracorporeal gas exchange in adult respiratory distress syndrome: associated morbidity and its surgical treatment.

Extracorporeal carbon dioxide removal (ECCO2-R) over a membrane lung is a new therapy for patients with adult respiratory distress syndrome (ARDS) who frequently suffer from lung complications caused by long-term artificial ventilation and who may require major thoracic surgery. This is a report of 76 patients with severe ARDS who were treated by ECCO2-R. Twenty-six of these 76 patients required thoracotomy: 19 for pneumothorax and pneumatocele, and seven for haemothorax, infected lung necrosis or oesophagotracheal fistula. Most pneumothoraces were bilateral. Ten of these 26 patients required reoperation, usually for extensive persisting alveolar air leaks. Sixteen (62 per cent) of the 26 patients who had a thoracotomy and 22 (44 per cent) of the 50 patients without surgery survived. These results demonstrate that performing a thoracotomy, if necessary, does not diminish the survival chance of high-risk patients with severe ARDS.

Adolescent↗
PubMed1990

Marburger concept for computer-aided acquisition, processing and documentation of patient data in the intensive care unit.

The authors report on their experience with the computer-aided acquisition, processing and documentation of patient data in an intensive care unit. The goal of an effective data and information collection system in the intensive care unit is to make therapy, and the patients respond to it, recognizable and understandable through the clear and complete representation of the patients conditions. The focal point of the data documentation is the medical record. In the implementation of a computer-aided data documentation and processing system the application of one central PC is unpractical. Each bed will be equipped with its own PC, and all the individual PCs will be connected to one central PC, which functions as server, and to connected to another PC in the doctors room. The data will be managed in a powerful database-management-system and be stored on an optical-disk. The development of an effective man/machine interface is especially important. In addition we can promote the user acceptance in other ways, so as to ensure a concrete benefit for each user group.

Electronic Data Processing↗
PubMed1990

[Extracorporeal membrane oxygenation and CO2 elimination].

The mortality in patients with ARDS stage IV is 90% according to the classification of Morel (1985) since all experiments as treatment with prostaglandine antagonists and application of antioxidants have to improve the outcome of such patients, we treated 87 patients, aged 5-51 years, between 1985-1990, with a veno-venous extra-corporeal bypass for CO2-elimination and with low frequency positive pressure ventilation according to the method of Kolobow et al. Forty-six of 87 patients survived, i.e. the mortality was reduced to 47%. This is striking evidence that this method is superior to other treatments of patients with ARDS.

Adolescent↗
PubMed1990

[The measurement of extravascular lung water--significant in the follow-up of ARDS?].

In 40 adult patients suffering from severe ARDS stage III and IV (Morel) we examined the course of the extravascular lung water (EVLW) measured by the double indicator dilution method with 858 single measurements, during mechanical ventilation with PEEP, or extracorporeal CO2 elimination (ECCO2 R). No correlation could be found between EVLW and the values of alveolar arterial oxygen difference (AaDO2) and intrapulmonary right-left shunt (Qs/Qt) or haemodynamic values such as CVP, PCWP, mean pulmonary arterial pressure, or the 24 h fluid balance. It was, therefore, not possible to estimate a prognostic trend based on a single measurement of EVLW. However, the course EVLW was more appropriate to perceive the prognostic trend of ARDS because a rapid decrease of very high EVLW was correlated with a decrease of AaDO2 (r = 0.87); whereas lethal ARDS (fibrosis) was associated with moderately increased, unchanged EVLW. However, during the ECCO2-R treatment the repeated estimation of EVLW and AaDO2 is a useful tool to assess recovery because other parameters such as Qs/Qt and chest computer tomography during long-term bypass are very difficult or impossible to employ for this purpose. A change of EVLW with increasing PEEP level could not be found. The reproducibility of 858 EVLW values was excellent with a coefficient of variation of 4.9 +/- 3.5%.

Adolescent↗
PubMed1990

[Surgical therapy of lung complications of long-term ventilation for severe adult respiratory distress syndrome].

Long-term respiratory therapy with high pressure levels in case of ARDS can lead to several symptoms requiring surgical treatment. Various forms of manifesting barotrauma predominate (bronchopleural fistula, pneumothorax, pneumatocele and soft tissue emphysema), while hematothorax, infected necrosis of parenchyma or esophagotracheal fistula are rare. Most of the operations became necessary because of bronchopleural fistula resp. pneumothorax, and with this indication the number of reoperations was especially high. Of 21 patients 13 (62%) survived.

Adolescent↗
PubMed1989

[Adult respiratory distress syndrome in legionella pneumonia--successful treatment with extracorporeal CO2 elimination procedures].

We report on successful treatment of an 46-year-old patient with ARDS (Adult Respiratory Distress Syndrome), caused by legionella-pneumophilia-pneumonia. The treatment with conventional artifical mechanical ventilation had failed. The new method of extracorporeal CO2-Elimination and low frequency positive pressure ventilation (ECCO2-R-LFPPV), introduced by L. Gattinoni (2) was in that case of severest ARDS very helpful. Supported by antimicrobial therapy with Erythromycin and Rifampicin the lung function could be improved to "restitutio ad integrum". Changes in chest radiographs, clinical parameters of ventilation, gas exchange and haemodynamics as well as the results of sequential pulmonary studies are demonstrated and discussed.

Carbon Dioxide↗
PubMed1989

[Personal experiences with extracorporeal CO2 elimination in patients with severe ARDS--a current review].

The method of extracorporeal CO2 elimination (ECCO2-R) as described by Luiciano Gattinoni and Theodor Kolobow is compared with earlier extra corporeal methods such as extracorporeal membrane oxygenation. The physiological fundamentals of the method, as well as indications and contraindications are explained. - The results of more than 100 patients treated worldwide are discussed together with the present problems of the method. In cases of severe ARDS stage IV, ECCO2-R definitely reduces mortality.

Carbon Dioxide↗
PubMed1989

[Dosage adjustment of drugs during continuous hemofiltration. Results and practical consequences of a prospective clinical study].

In 43 ICU patients undergoing continuous volume constant hemofiltration (CVHF), the pharmacokinetics of 12 drugs were investigated to ensure correct dosage adjustments. Under conditions of CVHF, maximum doses were defined for cefotaxime, ceftazidime, digoxin, digitoxin, imipenem, metronidazole++, netilmicin, phenobarbital, phenytoin, theophylline, tobramycin, and vancomycin. For the estimation of sufficient doses without blood level measurements, sieving coefficients (S) were calculated by a new method. In addition, S was integrated as a CVHF-specific factor into a common equation for drug dose adjustment in patients with renal insufficiency. The regression of dosage received from kinetics on blood-level-independent equation adjustment was r = 0.9923. Since the volumes of distribution in ICU patients are variable, it is suggested that further drug monitoring is necessary for toxic drugs.

Adult↗
PubMed1988

[Risk assessment and preliminary treatment in patients with esophageal cancer].

In 36 patients who underwent surgery for carcinoma of the oesophagus (21 patients subjected to blunt mediastinal dissection, 15 to thoracotomy) the preoperative status was determined by means of cardiopulmonary stepwise diagnosis and an individually adapted concomitant therapy was performed. A scheme for preoperative risk assessment which is equally important for both methods was evolved from the postoperative changes of VC, FEV1 and the preoperative values for RV/TLC, FEV1/VC, paO2 and paCO2 after retrospective analysis of the individual complication rates (60% cardiopulmonary). The 30-day lethality was 11%.

Adult↗
PubMed1987

[Experience with extracorporeal CO2 elimination].

The method of extracorporeal CO2-elimination (ECCO2-R) as described by L. Gattinoni [2] and Kolobow [5] is reported in ten patients with severe ARDS in whom conventional respirator therapy had failed. The method itself as well as important pulmonary function parameters, e.g. changes in gas exchange (Fig. 3), extravascular lung fluid (Fig. 6), and chest radiographs are explained. After 7-17 day treatment with the Life-Support System (LSS), seven patients were in satisfactory condition to allowing weaning from the ventilator (Responder). In three cases the lung mechanics and gas exchange were unchanged by the therapy with CO2 removal and high PEEP (Nonresponders). In the responders, oxygenation improved and the intrapulmonary shunt Qs/Qt (Fig. 4) decreased, followed by extravascular lung water and mean pulmonary arterial pressure (Fig. 5). Towards the end of the therapy we could find normalization of the compliance (Fig. 7) and chest X-rays, which may be interpreted as a cure. The results confirm our theory that ECCO2-R in combination with high PEEP and low-frequency ventilation seems to be an important method for future therapy of acute pulmonary failure.

Acute Disease↗
PubMed1987

[ARDS in Mycoplasma pneumonia].

In this paper we describe a case of bilateral broncho-pneumonia due to invasion by mycoplasma pneumoniae, leading to ARDS. A high serum level of cold agglutinins, a mild haemolysis and a rash resembling that of an erythema multiforme were noted. The initial treatment was non-specific. After pathogen identification tetracycline therapy was initiated. Bacterial superinfections were treated with appropriate antibiotic schemas. The observed biphasic clinical course could be explained as an immunological phenomenon.

Adult↗
PubMed1986

[Hemodynamic effects of nalbuphine in patients with acute respiratory insufficiency].

Examination of haemodynamic changes, after 20 mg nalbuphine had been administered IV to 11 ventilated patients with acute respiratory failure, showed that on average pulmonary arterial mean pressure increased by 8% of the initial value. This increase was reversed after the test dosage was doubled from 20 mg to 40 mg nalbuphine. Regression analysis of the correlation between changes in pulmonary arterial mean pressure and patient age resulted in an increase in mean pressure by 0.1 mmHg per year after 20 mg nalbuphine. These findings suggest that nalbuphine must be carefully monitored in elderly and pulmonary risk patients.

Adolescent↗
PubMed1985

[How reliable is a hot-wire anemometer?].

To examine the advantage of hot-wire anemometer for clinical use, we have checked two types of this tools with respect to reliability and validity. It was found that electronic suppression of noise caused a distortion of the measurements. Furthermore changes of transducers were also responsible for deviations from true values. We require of the manufacturer to indicate the threshold of perception and the coefficient of variation for repeated measurements with several transducers. We recommend a simple rule which permits an estimation of the limits of reliable measurements for clinical use depending on the threshold of the equipment and on the parameters of ventilation.

Humans↗
PubMed1985

[Bupivacaine 0.5% CO2 in spinal anesthesia].

The clinical usage of 0.5% bupivacaine-CO2 for spinal anaesthesia was tested in 45 patients. The use of bupivacaine CO2 is safe, segmental dificits were not observed. Compared to bupivacaine-HCl the latency period is shorter (7.7 min), whereas the duration of maximal analgesic spread (105 +/- 31 min) is identical. 93% of the patients had a complete motor blockade. The solubility of bupivacaine-CO2 in CSF (1.75 mg ml-1) is more than double the solubility of bupivacaine-HCl (0.8 mg ml-1), thus lowering the risk of precipitation.

Anesthesia, Spinal↗
PubMed1984

[Bilateral pneumothorax following laparoscopy].

A case of laparoscopy is presented with postoperative large subcutaneous emphysema and bilateral pneumothorax. As a result of careful control, conservative treatment, and consequent oxygen administration, this life-threatening phenomena disappeared within a short time. Preventive measures for complications of diagnostic laparoscopy are discussed and established to lower the anaesthetic risk of this widely practised procedure.

Adult↗