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Biomedical subjects

I Schindler

Publications and source records attributed to I Schindler.

At least 19 recordsLinked to original sources
PubMed1992

Effects of nimodipine administration during cardiopulmonary resuscitation in pigs.

The haemodynamic effects of nimodipine during cardiopulmonary resuscitation (CPR) were investigated in 25 anaesthetized pigs. After 5 min of ventricular fibrillation (VF) and 5 min of closed-chest CPR, adrenaline (50 micrograms kg-1), either nimodipine (10 micrograms kg-1 as a bolus followed by 1 microgram kg-1 min-1 continuously) or the equivalent volume of placebo (solvent for nimodipine) were administered followed by the first countershock. If this failed to restore spontaneous circulation, adrenaline and countershocks were repeated for a maximum of 30 min. CPR was successful in nine out of 10 nimodipine-treated animals, but only in six out of 15 placebo-treated animals (P less than 0.02). In resuscitated pigs there were no significant differences in the number of countershocks, the number of seconds required for restoration of spontaneous circulation and the total doses of adrenaline required for both nimodipine and placebo pigs. After restoration of spontaneous circulation haemodynamic responses to nimodipine were characterized by decreases in systemic vascular resistance and mean arterial pressure with consequent increases in heart rate and cardiac output, but they were not significantly different from those of the placebo-treated animals. We therefore conclude that high doses of nimodipine are well tolerated during and after CPR; nimodipine administration may even result in higher initial CPR success rates. The underlying mechanisms need further investigation.

Animals↗
PubMed1990

[Plasma proteins in the early postoperative course after liver transplantation].

The levels of fibronectin, alpha-1 antitrypsin, and fibrinogen have been studied in 34 patients after orthotopic liver transplantation (OLT). Patients were grouped according to A: postoperative course without complications (n = 18), B: development of sepsis accompanied by organ insufficiency (n = 8), and C: acute rejection (n = 6). The plasma levels of alpha-1 antitrypsin and fibrinogen did not show a typical pattern with respect to the postoperative course. The levels of fibronectin, however, did respond to the postoperative events. Starting from a subnormal level a significant increase was observed in group A (p less than 0.005) and C (p less than 0.05) whereas in group B plasma levels remained low. Significant differences (p less than 0.05) were found on day 3 and 5 between group A and C and group B and C. At the end of the observation period survivors (group A and C) had significantly higher levels of fibronectin than nonsurvivors (group B). Therefore fibronectin might aid to diagnose immunologic disturbances after OLT.

Adult↗
PubMed1987

[Comparative review of various resuscitation procedures].

During the last 10 years many experiments have confirmed the theory that blood flow during CPR likely occurs as a result of manipulation of intrathoracic pressure. In order to improve vital organ perfusion by increasing intrathoracic pressure many different techniques of CPR have been developed. These include "new CPR" (simultaneous ventilation and compression), asynchronous ventilation, prolonged compression, and continuous or interposed abdominal compression. Other methods like open chest CPR and the use of mechanized CPR or even cardiopulmonary bypass have also recently been proposed. All these techniques are reviewed in detail.

Heart Arrest↗
PubMed1987

[Results of cardiopulmonary and cerebral resuscitation in the area of surgical intensive care].

In intensive care units specially trained staff and sophisticated technical equipment are confronted with extremely critically ill patients. In this patient population multiple organ failure is mostly established thus requiring application of all therapeutic facilities. During a study period of 40 months in 203 (86.4%) out of 235 patients with cardiac arrest a decision not to resuscitate ("DNR order") was made. In 32 patients cardiopulmonary resuscitation was attempted. Although spontaneous circulation could be maintained for at least 12 hours in 40.6% (13 patients), 6 died within the first day and 3 other patients died during the first week. Only 4 patients resuscitated could be discharged. Our data suggest that, despite further development of technical and therapeutic methods, the underlying disease has to be considered as the limitation of long-term survival.

Adolescent↗
PubMed1986

[Glucose-potassium-insulin in hypodynamic septic shock].

Haemodynamic and metabolic effects of glucose-potassium-insulin (GKI) were studied in 14 patients with peritonitis. Study entry criteria were: hypodynamic septic shock (mean arterial pressure less than 50 mmHg and cardiac index less than 3.5 l/min) despite a highly positive fluid balance (greater than +2,000 ml during the last 12 h) and use of catecholamines (greater than 15 mcg/kg/min Dobutamine). GKI (glucose 70% 1 g/kg + potassium 10 mval + insulin 1.5 U/kg) was infused within 15 min via a central venous catheter. Before and 10 min after GKI haemodynamic and metabolic measurements were performed. GKI led to significant increases in systolic (+53%) and mean (+61%) arterial pressures, cardiac index (+50%), right (+60%) and left (+109%) ventricular stroke work indices, and oxygen consumption index (+18%). Heart rate remained unchanged, pulmonary shunt fraction increased slightly, systemic and pulmonary vascular resistances showed an insignificant decline. Serum glucose (p less than 0.01) and pCO2 (p less than 0.1) increased. The haemodynamic improvement lasted from 30 min or less (n = 3; 21%) to several hours. Nine patients (64%) survived more than 2 days, and two patients (14%) were eventually discharged from the hospital. We conclude, that in hypodynamic septic shock refractory to volume loading and catecholamine treatment GKI may be beneficial, although the mechanism of action remains unclear.

Adult↗
PubMed1986

[Acute renal failure in abdominal infection. Comparison of hemodialysis and continuous arteriovenous hemofiltration].

58 patients with peritonitis and acute renal failure (ARF) were treated either by haemodialysis (HD, n = 22), continuous arteriovenous haemofiltration (CAVH, n = 9), or continuous pump-driven haemofiltration (CPDHF, n = 27). In contrast to HD, which led to severe hypotension in 31.9% of procedures and to cardiac arrest in 3 cases, CPDHF caused neither haemodynamic nor metabolic alterations. Control of uraemia was most effective in the CPDHF group, too. Mean daily BUN and creatinine values fell significantly (p less than 0.005) and remained at 60 mg % and 2.0 mg %, respectively, whereas during HD no significant changes were found. During CAVH serum creatinine showed an insignificant decline, whereas BUN even increased. Despite higher costs CPDHF seems to be a promising alternative to HD or CAVH for treatment of ARF in septic patients, as mortality was lower in the CPDHF group and recovery of renal function occurred in 48.2%, whereas during HD only 27.3% recovered from ARF.

Acute Kidney Injury↗
PubMed1985

[Problems of blood replacement in liver transplantation].

Liver transplantation often is accompanied with massive bleeding-blood losses up to 125 I have been reported. A survey of 21 transplantations describes the management for substitution of blood components. After an initial series of 18 patients including 4 cases with blood losses exceeding 100 units of blood, an attempt was made to optimize coagulation in 5 cases with NT-values below 40% by preoperative plasmapheresis. Platelet transfusion was performed in all cases with platelet values below 120 000. These measures led to a significant reduction in blood units substituted during the last 9 transplantations.

Adult↗
PubMed1985

[Pathogenic flora in the gastric juice and bronchial secretion of long-term ventilated intensive-care patients].

Nosocomial pneumonia is a major risk for long term ventilated ICU patients. The infection route may be hematogenic or via inhalation or aspiration of microorganisms. The source of aspiration is the oropharynx. This prospective study intended to study the role of the stomach as a reservoir of bacteria in ICU patients treated with cimetidine. Gastric juice and bronchial secretion from 34 patients ventilated for more than 4 days were examined bacteriologically. 72,8% of the gastric (G) and 79,1% of the bronchial aspirates (B) revealed significant bacterial growth (more than 10(4) microorganism/ml). Pseudomonas, Klebsiella, and Candida spp. were found in 56,7% (B) and 51,8% (G) of the positive cultures as an effect of selection caused by antibiotics. Organisms of intestinal origin were found in 17,8% (B) und 15,5% (G), respectively. In 32,5%, identical organisms or patterns of organisms were found in the gastric and bronchial aspirates. 7 of the 34 patients (20,6%) developed pneumonia; in 6 of these 7 cases, the same organisms could be identified at the same and/or at the last examination before developing pneumonia in gastric content and bronchial secretion. The pH-value of the sterile aspirates was lower than of the colonized aspirates (5,39 vs 5,99). During enteral nutrition, 31,4% of the aspirates were sterile, whereas during parenteral nutrition only 24,3% of the gastric aspirates were sterile. Therefore, enteral nutrition should be started as soon as possible, the pH-value should be checked frequently and should not exceed 4 in order to reduce bacterial overgrowth in the stomach. A further consequence is to use as few antibiotics as possible.

Adult↗
PubMed1985

[Monitoring kidney function in abdominal infection].

In ICU patients suffering from abdominal sepsis acute renal failure (ARF) is a common (50% incidence) and often lethal (more than 80% mortality) complication. Continuous monitoring of renal function is necessary for both adequate fluid replacement and early detection of ARF. Using a programmable handheld computer the following parameters are calculated at least daily: creatinine, osmolal and free water clearance, fractional excretion of sodium and potassium and non-saline loss. The clearance values are corrected to 1.73 m2 body surface area. Free water clearance proved to be a particularly valuable guide for fluid therapy as well as for early diagnosis of ARF. In all septic patients renal function is impaired to some degree, since despite increased cardiac output creatinine clearance is only normal or even decreased. More than 50% of our patients with abdominal sepsis develop ARF, resulting in a dramatic increase in mortality. Goal of renal monitoring in sepsis is to detect ARF as early as possible and to differentiate between extrarenal and septic origin to enable immediate surgical treatment.

Acute Kidney Injury↗
PubMed1985

[Continuous hemofiltration in peritonitis].

During a period of 3 years 27 patients in acute renal failure (ARF) due to peritonitis underwent pump driven continuous hemofiltration (PDHF). PDHF caused neither hemodynamic nor metabolic disturbances, which in contrary are frequently seen during intermittent hemodialysis treatment in septic patients. BUN and creatinine levels fell significantly (p less than 0.001) and remained at 60 mg% and 2.0 mg%, respectively (mean values). Severe coagulation disorders occurred in 5 patients; in 2 patients PDHF was continued under protamine administration into the venous line, in 3 patients PDHF was stopped for 24 hours and than started again. Bleeding stopped in all cases, therefore surgery was not necessary. Other major complications of PDHF were not observed. Kidney function recovered in 44.4% of patients, and mortality was 70.4%. This is clearly lower than in abdominal septic patients under intermittent hemodialysis. Despite much higher costs (2.5 times the costs of hemodialysis treatment per day) PDHF seems to be a promising alternative in the treatment of ARF complicating septic multiple organ failure.

Acute Kidney Injury↗
PubMed1985

[Evaluation of the thermal technic for the quantitative measurement of extravascular lung water].

To evaluate the accuracy of the method, sequential measurements (n = 159) of extravascular lung water (EVLW) using the thermo-dye double-indicator dilution technique were performed in 22 critically surgical ill patients. Radiographic grading of lung water content served as clinical standard. Normal mean EVLW defined radiographically without evidence of pulmonary edema was 4.8 +/- 1.1 ml/kg. Early interstitial fluid accumulation was quite accurately detected with 6.9 +/- 2.1 ml/kg EVLW (p less than 0.001 vs normal lung water content). The mean EVLW present with definitive interstitial and alveolar edema was 11.5 +/- 3.8 ml/kg and 19.1 +/- 4.5 ml/kg, respectively. Despite some objections to the method (diffusion limitation of the thermal indicator, uneven regional lung perfusion), this technique for measuring EVLW reliably assesses the degree of pulmonary edema. Even when properly performed, chest roentgenograms only confirm gross changes in the lung water content.

Adolescent↗