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K F Bodmann

Publications and source records attributed to K F Bodmann.

15 recordsLinked to original sources
PubMed2005

Current guidelines for the treatment of severe pneumonia and sepsis.

UNLABELLED: Infections in intensive care unit (ICU) patients like severe pneumonia, e.g. nosocomial (NP) and community-acquired pneumonia (CAP), or septicemia must be treated promptly and effectively because of the ensuing high mortality. Treatment is thus empirical and starts before the results of microbiological cultures are known. The risk factors affecting mortality include severity of illness, virulence of etiologic pathogens and the use of inappropriate antibiotic therapy. Several studies have shown that modifying initially inadequate therapy, according to microbiological results, does not result in a better outcome. Due to this, antibiotic treatment requires agents which have an appropriate spectrum covering the likely pathogens causing these infections. In critically ill patients, the need for empirical first-line treatment covering a broad spectrum of Gram-negative and Gram-positive bacteria, as recommended in international guidelines (e.g. those of the American Thoracic Society or the Infectious Diseases Society of America), is justified in the presence of resistant organisms commonly documented in these patients. To choose an appropriate, initial antibiotic regimen, local and national resistance data have to be considered. With respect to new German resistance trends in Gram-negative and Gram-positive bacteria, the Paul Ehrlich Society of Chemotherapy has recently published guidelines for the treatment of infections in hospitalized patients. Especially in ICU patients with severe pneumonia (NP or CAP) or septicemia and risk factors like underlying diseases, antibiotic pretreatment or mechanical ventilation, agents with an appropriate spectrum encompassing Pseudomonas aeruginosa as well as other Gram-negative bacteria like Escherichia coli, Klebsiella spp., Enterobacter spp. and Gram-positive bacteria (e.g. Staphylococcus aureus, pneumococci and streptococci) are recommended as treatment of choice. Combination therapy with an anti-pseudomonal beta-lactam and a fluoroquinolone or an aminoglycoside are recommended for these patients to provide the necessary spectrum of activity and to prevent the emergence of resistant organisms. On the other hand, clinical trials and meta-analyses have shown the efficacy, tolerability and cost-effectiveness of monotherapy regimens even in critically ill and immunocompromised patients. CONCLUSION: Appropriate beta-lactam antibiotics recommended in international and German guidelines for the treatment of severe CAP, NP and septicemia, either as monotherapy or as combination therapy, are the 4th generation cephalosporin cefepime, the carbapenems imipenem and meropenem, and the acylamino-beta-lactamase inhibitor combination piperacillin-tazobactam.

Anti-Bacterial Agents↗
PubMed1997

[Epidemiological and prognostic data from 2054 patients of an internal medicine intensive care unit].

BACKGROUND: Computer-based data collection and objective gathering of degree of illness severity and risk of death with a prognostic scoring system make it possible to obtain, in addition to epidemiological and aetiological data, risk-related outcome values for patients in an intensive care unit. PATIENTS AND METHODS: All 2054 patients who during a 2-year period (1995-1996) had stayed in a medical intensive care unit (MICU) for more than 4 hours were studied prospectively. The simplified acute physiology score II (SAPS II), risk of death, duration of stay in the MICU and in the hospital, and death rates during MICU and hospital stay were determined. Mean and median values and histograms of the various parameters as well as the standardized mortality index (SMI: observed/ predicted death rate with 99% confidence limits) were calculated for each of the patients and certain defined subgroups (basic disease, age, risk). Receiver operating characteristics curves (discrimination) and calibration curves were obtained for SAPS II. RESULTS: Mean age for the cohort was 59.8 years, duration of stay in the MICU 3.1 days, in hospital 14.7 days, SAPS II was 30.3 points, death risk 0.17, death rate during ICU stay was 8.3%, during hospital stay 13.9% and the SMI 0.8% (0.74-0.88). Cardiac disease was the most common underlying condition (60%), while the small group of neurological conditions was remarkable for the high degree of severity and unfavourable prognosis. Both death rate and degree of disease severity increased with age. But the SMI was not significantly higher than 1.0 in both the elderly patients and the high-risk group of patients (on ventilator, renal replacement procedures, death risk > 0.5). CONCLUSIONS: Most patients in a MICU have underlying cardiac disease. Permanently available neurological consultation is essential. The high hospital death rate for elderly patients and those requiring respiratory support is a problem of disease severity, not of the quality of treatment. The risk of death is high on transfer to a general ward. Determination of the SMI is recommended for internal quality control in an ICU.

Adult↗
PubMed1997

[Plasma amino acid concentrations and isoleucine-phenylalanine quotient in patients with acute myocardial infarct during amino acid infusion].

AIM: The influence of substitution with two different amino acid solutions on changes in plasma amino acids were studied in patients with acute myocardial infarction. PATIENTS AND METHODS: Thirty consecutive patients admitted to an intensive care unit were included in this open, nonrandomized study. The isoleucine-phenylalanine-concentration ratio was calculated. Patients of the treatment groups received 10 ml/kg BW/24 h of 10% amino acid solutions intravenously (1 g/kg BW/24 h). Patients of group 1 received Intrafusin 10%, patients of group 2 Aminosteril 10%. Ten patients (group 3) were infused with 10 ml/kg BW/24 h isotonic electrolyte solution (Jonosteril and served as a control group. All infusions were performed over a 96 hour period. RESULTS: All infusion of amino acid solutions increased the plasma concentrations of most amino acids without a significant impact on the pattern of amino acids over time. Significant increases in plasma concentrations together with a significant variation over time were observed for glycine, isoleucine, proline, alpha-amino-butyric-acid and glutamine. A significant difference in relation to the type of amino acid solution was observed for isoleucine and proline (rapid increase and higher concentrations with Aminosteril), and glutamine (rapid increase and higher levels with Intrafusin). CONCLUSION: The isoleucine-phenylalanine-ratio increased from initially decreased values between 0.9 and 1.0 during amino acid infusion and reached the level of 1.25 found in healthy persons in patients with Intrafusin infusions.

Aged↗
PubMed1997

The ability of the Simplified Acute Physiology Score (SAPS II) to predict outcome in coronary care patients.

OBJECTIVE: To evaluate the applicability of the Simplified Acute Physiology Score (SAPS II) for coronary care patients. DESIGN: Prospective observational cohort study. SETTING: Medical ICU of a community teaching hospital. PATIENTS: 1587 consecutive patients admitted over a period of 18 months. MEASUREMENTS AND MAIN RESULTS: Patients were divided in two groups according to the primary admission diagnosis: general medical intensive care (ICU) patients and intensive coronary care (CCU) patients. Score prediction was tested using criteria suitable to evaluate the discrimination and calibration properties of SAPS II. Mean SAPS II score was 31.6 (+/- 20.1) in ICU and 28.3 (+/- 15.5) in CCU patients (p = 0.06), mean risk of death 0.206 and 0.134 (p = 0.001), and observed hospital mortality 17.8 vs 10.3%. The area under the receiver operating characteristic curve was 0.888 in ICU and 0.908 in CCU patients (p = 0.5). The correlation between predicted and observed hospital mortality was 0.62 (p = 0.001) in ICU and 0.66 (p = 0.001) in CCU patients. The calibration curves did not differ from each other. The probability of death in survivors and nonsurvivors was equally distributed in ICU and CCU patients (p = 0.5). CONCLUSION: We conclude that SAPS II is applicable to CCU patients in our unit.

APACHE↗
PubMed1995

[Diarrhea, coli infection, septic encephalopathy: escalation of a seemingly banal symptom].

Septic encephalopathy is an early manifestation of sepsis. Changes in consciousness, focal or generalized seizures, multifocal myoclonus and/or varying hemiparesis are common clinical findings. All of these symptoms are reversible when sepsis has been successfully treated. Because there are no generally accepted criteria for the diagnosis of septic encephalopathy, it is a diagnosis of exclusion. We report the case of a 68-year-old patient who developed septic encephalopathy secondary to diarrhea and E. coli sepsis. In this case, symptoms of septic encephalopathy were fully reversed after the patient's E. coli sepsis had been adequately treated.

Aged↗
PubMed1993

Hemodynamic profile of intravenous fenoldopam in patients with hypertensive crisis.

Fenoldopam, a newly developed intravenous dopaminergic DA1 receptor agonist, was used in an open, prospective study for blood pressure control in 12 patients presenting with hypertensive crisis. At a dose of 0.2-0.5 microgram kg-1 min-1 fenoldopam decreased systolic blood pressure from 209 +/- 13 to 151 +/- 17 mmHg and diastolic blood pressure from 114 +/- 10 to 78 +/- 10 mmHg. Blood pressure was controlled in all 12 patients within 5-50 min. In none of the patients did rebound hypertension occur upon termination of the study medication, nor was any adverse event reported. Major hemodynamic changes induced by fenoldopam were a decrease in total peripheral resistance from 1853 +/- 611 to 1193 +/- 368 and in pulmonary vascular resistance from 252 +/- 170 to 180 +/- 74 dyne s-1 cm-5. In patients with high left ventricular filling pressure at study pulmonary capillary wedge pressure decreased while the stroke volume index and mixed venous oxygen saturation increased under fenoldopam. Thus, fenoldopam appears to be a rapid-acting, well-tolerated, and highly effective intravenous substance for the treatment of severe hypertension.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed1993

[Behavior of plasma proteins and nitrogen balance in patients with acute myocardial infarct with and without intravenous amino acid administration].

OBJECTIVE: The goal of this study was to examine the behaviour of nitrogen balance and plasma proteins with or without intravenous supply of amino acids in patients with acute myocardial infarction. DESIGN AND PATIENTS: 30 consecutive patients who suffered from acute myocardial infarction and who were admitted to our medical intensive care unit were examined in an open, non-randomised study. SETTING AND INTERVENTIONS: The first 10 patients (group I) received 10% Intrafusin 10 ml/kg BW/24 h as a continuous intravenous infusion over a period of 96 h. Patients No. 11-20 (group II) received Aminosteril 10% 10 ml/kg BW/24 h also over a 96-hour period. Patients No. 21-30 (group III) were given intravenous infusions of Jonosteril 10 ml/kg BW/24 h for 96 h. RESULTS: The nitrogen balance demonstrated a statistically significant decrease in all groups (group I, 9.1 to 6.1 g/day; group II, 9.8 to 4.8 g/day; group III, 1.3 to -1.1 g/day); however, in groups I and II the nitrogen balance remained positive. The concentrations of total protein, transferrin, retinol-binding protein and pre-albumin decreased significantly. This decrease, however, was significantly less in patients given amino acid infusions. CONCLUSIONS: Infusion of amino acids in acute myocardial infarction results in a positive nitrogen balance and reduces the decrease in plasma protein concentrations. Further studies are required to judge the positive nutritive effect of amino acid infusions on the outcome of myocardial infarction.

Acute-Phase Proteins↗
PubMed1992

[Severe digitalis poisoning after the ingestion of 1 g of digoxin].

A 50-year-old, previously healthy, woman swallowed 1 g digoxin powder, dissolved in water, with suicidal intent. On admission to hospital one hour later, having vomited three times at home, the prominent signs were somnolence and hypersalivation. Serum digoxin level was 3.37 ng/ml. There followed repeated episodes of asystole alternating with ventricular fibrillation requiring cardiopulmonary resuscitation over 90 min and adrenaline administration. Repeated electrical defibrillation, administration of dopamine, phenytoin and lidocaine, as well as transitory transvenous electrical stimulation became necessary. Anti-digoxin antibody fragments were administered, initially 80 mg, to a total of 3,280 mg over 24 hours. After 3 days of intensive care and a further 21 days in hospital she was discharged and referred to psychiatric treatment. This case demonstrates that even severe digoxin poisoning can be successfully treated without sequelae by the appropriate administration of digoxin antidote. The main problems in this case were regulation of the dosage and acquiring the necessary amount of antidote which greatly exceeded the hospital's own depot.

Acute Disease↗
PubMed1991

[Atrial fibrillation in patients of a medical clinic--a marker for multi-morbidity and unfavorable prognosis].

Out of 724 patients admitted to the medical department of a community teaching hospital during three months 110 (14.5%) had electrocardiographically documented atrial fibrillation (AF). 56% had chronic and 44% intermittent AF. Only 66% of patients with AF suffered from diseases generally accepted as cause of AF, 29% had cardiovascular and pulmonary risk factors, 5% had lone AF. AF was already known in 66% of patients, in 21% AF was documented at the first time, only 14% were admitted because of AF, although AF was clearly the cause of symptoms in an additional 11%. The mean age of patients with AF (72 years) was higher than that of patients without AF. 95% of patients with AF suffered from more than one cardiovascular or pulmonary disease or risk factor (mean index of diseases of 3.2). Hospital mortality of patients with AF was much higher than mean total hospital mortality (19 vs 7.7) except in patients with lone AF. We conclude that AF is a marker of multimorbidity and bad prognosis in patients of general internal medicine.

Adult↗
PubMed1990

Comparative clinical trial of ceftazidime and imipenem/cilastatin in patients with severe nosocomial pneumonias and septicaemias.

The efficacy and safety of ceftazidime and imipenem in patients with severe infections was compared in a randomized multi-centre trial. Patients on assisted respiration with clinical signs of pneumonia or septicaemia who had been in hospital for at least 3 days were studied. Twenty-one patients were treated with ceftazidime, 24 with imipenem. The mean duration of treatment was 9 days in both groups. At the end of the trial 17 patients (81%) of the ceftazidime group and 16 patients (67%) in the imipenem group were clinically cured or showed marked improvement. The bacteriological results showed an eradication of the causative pathogens in 17 of 21 cases in the ceftazidime group and 13 of 19 in the imipenem group.

Ceftazidime↗
PubMed1989

[Incidence of intravenous thrombolytic therapy and fatalities in patients with acute transmural myocardial infarct (Q infarct). A study of observations from 1984 to 1987].

All patients admitted to the ICU with acute myocardial infarction (MI) were treated by the same protocol since 1984. We report the results in Q-wave-MI of 1987 compared to 1984. Age (67.2 +/- 12.4 vs. 66.8 +/- 11.4 years), sex distribution (70.1% vs. 71.9% male), time elapse between begin of symptoms and admittance to the hospital (15.5 +/- 27.0 vs. 15.0 +/- 32.5 hours) were similar in both years, but the total number of definite Q-MI decreased by 22% from 135 (1984) to 105 (1987). Inhospital mortality (20% vs. 23%) and ICU mortality (14% vs. 20%) tended to decrease, although differences did not reach statistical significance. This was paralleled by an increase in the rate of i.v. thrombolytic therapy from 17% (1984) to 28% (1987) of all patients with Q-MI. The percentage of patients who definitely received i.v. thrombolysis when all indication criteria were present and all contraindicatory factors excluded increased from 47% (1984) to 97% (1987). We conclude, that the performance of i.v. thrombolysis in all patients, who fulfill the general accepted criteria for thrombolysis may improve clinical course and outcome in a given population of patients with acute Q-wave-infarction.

Aged↗
PubMed1989

[Effectiveness and hemodynamic mechanism of action of blood pressure lowering by intravenous labetalol in patients with a critical increase in blood pressure].

Labetalol (L) was intravenously given to ten patients with an acute elevation of arterial blood pressure above to 200 to 100 mmHg. Blood pressure was controlled in 9 of 10 patients (less than or equal to 170/100 mmHg) with 50 mg in 4, 100 mg in 4 and 200 mg L in 1 patient. In 9 responders, systolic pressure decreased from 207 +/- 20 to 161 +/- 9, diastolic pressure from 107 +/- 11 to 90 +/- 8, and mean pressure from 140 +/- 11 to 113 +/- 5 mmHg, and all pressures remained at these levels during a 25 min control period. Heart rate decreased significantly from 87 +/- 20 to 69 +/- 11 per min and cardiac index from 3.2 +/- 0.8 to 2.6 +/- 0.61/min x m2. Stroke volume index remained unchanged. Total peripheral resistance and pulmonary artery occlusion pressure were not significantly altered but tended to increase, resulting in a small shift to the right of the ventricular function curve. Pulmonary vascular resistance increased significantly from 236 +/- 108 to 314 +/- 132 dyn x sec x cm-5 and mixed venous oxygen saturation decreased from 70 +/- 5 to 65 +/- 8%. Peripheral resistance was considerably higher and cardiac index lower in patients with a heart rate below 70/min. We conclude that L effectively lowers the arterial blood pressure in hypertensive crisis, but the substance should not be used in patients with heart rates below 70/min, as in this case the beta-blocking effect may supervene resulting in a high-resistance low-output state.

Adult↗
PubMed1989

[Predictive value of a combined physiologic-therapeutic oriented score system in patients of intensive internal medicine].

171 consecutive patients of a medical intensive care unit (age 18 to 81 years, mortality 24.6%) who were treated in the ICU for at least 72 hours were investigated in order to test the hypothesis, that the combination of therapeutic scoring (TISS) and physiologic scoring (APS) may improve the prognostic significance of score systems and/or the severity of disease classification in critically ill patients. Discrimination of survivors and non-survivors of the combined score was comparable to the results of isolated scores. A higher weighting of the physiology parameters in the combined score did not improve its prognostic significance. On the other hand, only the combined score implicated a linear increase of mortality with increasing score point values. - We conclude, that the combined score system improves the severity of disease classification in critically ill medical patients.

Adolescent↗