Biomedical subjects

O Karg

Publications and source records attributed to O Karg.

At least 19 recordsLinked to original sources

PubMed2005

[Recommendations for the treatment of respiratory complications in case of a viruspandemic].

In case of a viral pandemic without availability of effective vaccination, one can expect to be faced with additional 250 to 300 new admissions per hospital per week given the worst case scenario. Major complications are expected to occur in the respiratory system with the focus on viral pneumonia often complicated by bacterial superinfection. Frequently these patients will require artificial ventilation. The present infrastructure will not be capable of dealing sufficiently with such high numbers of casualties. These recommendations of the German Society for Pneumonology are based on the successful application of non-invasive ventilation for acute respiratory failure in recent years. It is of importance to achieve effective treatment by the use of relative simple means. The recommendation proposes to use a separate building in order to realize quarantine. In terms of diagnostic tools, a simple x-ray apparatus should be available. To monitor patients pulsoxymetry and ECG devices should be sufficient in most cases. For the treatment of acute respiratory insufficiency a sufficient number of ventilators, masks, tubing systems and filters should be kept in stock. In terms of medical treatment antibiotics to treat superinfections are of major importance. Analgesics, sedatives and intravenous fluids will also be needed. Oxygen should be available for every single patient. The recommendation gives detailed advise for the enforcement of hygiene control, diagnostic as well as therapeutic steps for in hospital treatment of high numbers of casualties of a viral pandemic.

Disease Outbreaks↗

PubMed2004

[Respiratory therapist: introduction of a new profession].

Respiratory therapists are healthcare professionals taking care of patients with pulmonary disorders. They are an allied health specialty, practicing under medical direction. The professionalism of nurses and therapists must grow up to act successfully in new fields of medicine, where evidence-based independent action is necessary. Specialized therapists can help us coordinate separated processes (diagnoses, therapy and nursing). The profession "Respiratory Therapist" was created in the United States 50 years ago. We intend to introduce this profession also in Germany. We follow many other countries who have already taken this step. We hope that we can reach yet a higher quality of patient care.

Evidence-Based Medicine↗

PubMed2003

[Noninvasive intermittent self ventilation in chronic respiratory insufficiency].

Corresponding to the two compartments of the respiratory system (lungs and ventilatory pump), two different forms of respiratory insufficiency can be distinguished on a pathophysiologic basis: disturbances of gas exchange with primary oxygenation failure (hypoxemia) due to pulmonary diseases and reduced ventilation of the lungs (hypoventilation) with primary elevated arterial carbon dioxide partial pressure (hypercapnia) and secondary hypoxemia due to disorders of the ventilatory pump. Different methods can be employed in the diagnosis of respiratory insufficiency, e.g., spirometry, blood gas analysis, nocturnal monitoring with capnography, or transcutaneous pCO2 registration and measurement of mouth occluding pressure. Therapeutic measures for respiratory insufficiency are based on two treatment principles: long-term oxygen therapy to improve hypoxemia and noninvasive ventilation therapy to improve hypercapnia and concomitant hypoxemia. The indication for long term ventilation depends on subjective complaints, objective measurement parameters, disease course, and other disease symptoms. The most frequent indications for home mechanical ventilation are diseases with restrictive ventilatory defects, especially chest wall disorders and neuromuscular disorders.

Dyspnea↗

PubMed1999

[Exercise tolerance of patients under nasal intermittent positive pressure ventilation (nIPPV)].

BACKGROUND: There are only a few papers concerning with exercise tolerance of patients under nasal intermittent positive pressure ventilation (nIPPV). PATIENTS AND METHOD: Therefore since 1996 we routinely checked exercise tolerance of our nIPPV-patients when admitted to the hospital. Till March 1997 we had carried out 1386-minute walking tests (6-min WT) in 111 patients. QUESTIONS: Is there an improvement of exercise tolerance in the course of nIPPV-therapy? Are hypoxemia or hypercapnia occurring during exercise-test? METHODS: The 6-min WT was performed after one practice walk. The patients got oxygen in case of a preexisting oxygen therapy or in case of an oxygen saturation below 85% before starting. Blood gas analyses were carried out before and after stopping the test. Oxygen saturation and heart rate were registered continuously. The distance walked was measured. Twenty-one patients were tested before introducing nIPPV therapy and 3 months after home mechanical ventilation (HMV). RESULTS: The average distance walked amounted only 283 +/- 82 m (norm in healthy persons: 800 m). pO2 decreased from 69 +/- 11 to 58 +/- 12 mm Hg, pCO2 increased from 47 +/- 8 to 49 +/- 8 mm Hg. Oxygen saturation (SaO2) fell from 92 +/- 5 to 80 +/- 10%, heart rate increased from 104 +/- 18 to 130 +/- 23 beats/min. The distance walked changed not significantly from 282 +/- 109 to 308 +/- 71 m. Six patients could be tested a 3rd time after 6 months HMV. The distance walked was 315 +/- 103 m (also no significant difference). CONCLUSIONS: Everyday activity can cause severe hypoxemia in nIPPV patients. Ambulatory oxygen therapy should be considered in each case. A significant improvement of exercise tolerance under nIPPV therapy is not yet proven. Our data only show a tendency towards an increase.

Exercise Tolerance↗

PubMed1999

[Long-term breathing via tracheostoma].

PATIENTS AND METHODS: From 1988 to 2/1997 we had introduced intermittent positive pressure ventilation (IPPV) in 298 patients. In most cases non-invasive nasal mask ventilation was possible, in 21 patients (7%) a tracheostoma was necessary. These 21 patients were analysed retrospectively due to age, sex, diagnose, ventilation mode, course of illness, home care and costs. RESULTS: We had 13 male and 8 female patients, aged 49 years on average (min. 2, max. 84). 90% had neuromuscular diseases especially muscle dystrophies. Ventilation therapy was performed volume controlled with the cannula unblocked during daytime and blocked at night. Eighteen patients had industrial cannulas (72% Shiley, 28% Rüsch), 3 patients used silver cannulas. Daily ventilation amounted 24 hours in 7 patients, 6 to 14 hours in 14 patients. During the observed time 7 patients remained in stable health situation, in 9 patients the underlying disease was progressive and 5 of them died. IPPV was performed 50.7 months on an average, in living patients 68.8 months, in died 7.6 months. Fifteen patients lived at home, 5 were cared in nursing home, 1 patient stayed in hospital. Outside the hospital the bigger part of costs was paid by sick funds and care funds, the smaller part by social welfare offices. Often costs were divided. Total costs for caring about 24 hours ventilated patient at home amounted up to 21,000 German marks each month.

Adolescent↗

PubMed1999

[Diaphragm pacing in chronic hypoventilation].

BACKGROUND: Diaphragm pacing in patients with intact phrenic nerve and diaphragm can be used as an alternative to mechanical ventilation. Indications cover diseases caused by central hypoventilation like C2-quadriplegia and Ondine's syndrome. Advantages are physiological ventilation with negative pressure and an improvement in articulation. CASE REPORT: We report our experiences with a patient suffering from chronic hypoventilation caused by a ventilatory pump failure following tetraparesis due to congenital toxoplasmosis.

Adult↗

PubMed1999

["Ondine's curse" in adults].

The term "Ondine's curse" is normally used for congenital central hypoventilation in children. We report on 10 adult patients with this disorder (average age 46 y), who were treated from 1990 to 1996. They were hypercapnic while awake (mean 57 Torr) and during sleep (mean 87 Torr). The CO2-rebreathing response was negative. During exercise test minute ventilation volume did not rise adequately (mean pCO2 : 63 Torr, mean pH: 7.21). Five of these patients underwent emergency intubation before diagnosis, 2 presented with hypoventilation syndrome and 2 with decompensated cor pulmonale, 1 was diagnosed without complaints. 8 patients needed intermittent positive pressure ventilation therapy, 7 of them noninvasive, 1 via tracheal canula. One female patient has already died, the others are under stable clinical condition with the underlying central disorder remaining unchanged. Only 2 patients showed central defects visible in magnetic resonance tomography.

Adult↗

PubMed1999

[Limitations of noninvasive mask ventilation in acute hypoxemic gas exchange disorders (COPD)].

The benefit of noninvasive mask ventilation (NIMV) compared to mechanical ventilation after intubation is proven in patients with acute exacerbation of COPD. Contrary to this point the benefit is not clear in patients with acute gas exchange failure, such as in pneumonias. We tried to evaluate the efficiency of NIMV in this indication in a clinical case series. We treated 31 patients with acute gas exchange failure (pO2 52 +/- 11 Torr, APACHE II Score 20 +/- 7) with NIMV. In 18 patients (58%) blood gases improved. But during the further course 2 patients were intubated, 3 patients died. In 13 patients mask ventilation was stopped because of ineffectivity. 11 patients were intubated, 8 patients died. 3 patients were not intubated for ethical reasons. The success rate is about 20% lower than in patients with acute ventilatory insufficiency. NIMV can be used in patients with severe gas exchange failure. Until now, however, no data are available proving that the method offers significant advantages over intubation and mechanical ventilation.

APACHE↗

PubMed1999

[Physical performance in home ventilation patients].

Since 1995 we control the physical performance of our NMV patients using the six-minute walk test (6 MW). To determine the effects of ventilatory therapy on the physical performance a 6 MW was done before starting ventilatory support in 37 patients and repeated 3 (n = 33), 9 (n = 19) and 15 (n = 19) months after. Three months after the beginning of NMV therapy our patients significantly increased the distance achieved during 6 MW up to 120% and then remained stable for up to 15 months control time. We believe this effect is predominantly achieved by the ventilation therapy since no other therapy was done, especially no additional physical training. Furthermore, we studied 3 other patients ventilated for more than one year who underwent an additional physical training programme as in COPD patients for rehabilitation. The effects of this training were controlled by a 6 MV and by the determination of the VO2 max before and after training. All 3 patients under already instituted and current therapy increased their walking distance and 2 of them their VO2 max after training. This indicates a possible additional benefit in individual cases.

Home Care Services↗

PubMed1998

[Noninvasive intermittent self-ventilation as a palliative measure in amyotrophic lateral sclerosis].

Almost all patients with amyotrophic lateral sclerosis (ALS) experience symptoms of nocturnal hypoventilation during the course of the illness. These symptoms can develop years before death and may severely affect quality of life. Non-invasive intermittent home mechanical ventilation (HMV) via mask is a possible palliative measure for these symptoms, which is not often used in Germany. We report on our experience with HMV in 24 patients with ALS. Our data show a good palliative effect in 17 of 24 treated patients. Severe complications did not occur. The mean ventilation time at present is 14 months. Available options and their consequences need to be discussed in detail with patients and relatives before HMV is initiated.

Adult↗

PubMed1998

Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial.

OBJECTIVE: To evaluate the effectiveness of lymphadenectomy in the treatment of non-small cell lung cancer (NSCLC). SUMMARY BACKGROUND DATA: The extent of lymphadenectomy in the treatment of NSCLC is still a matter of controversy. Although some centers perform mediastinal lymph node sampling (LS) with resection of only suspicious lymph nodes, others recommend a radical, systematic mediastinal lymphadenectomy (LA) to improve survival and to achieve a better staging. METHODS: In a controlled, prospective, randomized clinical trial, the effects of LA on recurrence rates and survival were analyzed, comparing LS and LA in 169 patients with operable NSCLC. RESULTS: After a median follow-up of 47 months, LA did not improve survival in the overall group of patients (hazard ratio: 0.78; 95% confidence interval: 0.47-1.24). Although recurrences rates tended to be reduced among patients who underwent LA, these decreases were not statistically significant (hazard ratio: 0.82; 95% confidence interval: 0.54-1.27). However, analysis of subgroups of patients according to histopathologic lymph node staging revealed that LA appears to prolong relapse-free survival (p = 0.037) with a borderline effect on overall survival (p = 0.058) in patients with limited lymph node involvement (pN1 disease or pN2 disease with involvement of only one lymph node level); in patients with pN0 disease, no survival benefit was observed. CONCLUSIONS: Radical systematic mediastinal lymphadenectomy does not influence disease-free or overall survival in patients with NSCLC and without overt lymph node involvement. However, a small subgroup of patients with limited mediastinal lymph node metastases might benefit from a systematic lymphadenectomy.

Carcinoma, Non-Small-Cell Lung↗

PubMed1997

[Noninvasive ventilation in acute respiratory insufficiency].

BACKGROUND AND AIM: Noninvasive positive pressure ventilation (NPPV) via face mask offers in comparison to endotracheal intubation in treating patients with acute respiratory failure (ARF) advantages like allowing swallowing and coughing. We report our experiences and try to verify the indications and the efficacy of NPPV. PATIENTS AND METHODS: In the period of January 1991 until August 1996 109 patients (30 female, 79 male, mean age 61 +/- 12 years) received mechanical ventilation with NPPV representing 25% of all MVs in this term. As baseline capillary blood gases (CBG) were found: pH: 7.30 +/- 0, 10; pCO2: 64 +/- 19; pO2: 60 +/- 19 (all patients received supplemental oxygen). Success of NPPV was determined by an improvement of the baseline CBG. RESULTS: NPPV was successful in 77 (71%) patients. Considering the kind of respiratory insufficiency the patient population was divided into 4 groups 1. acute hypoxemic respiratory failure, 2. acute hypercapnic ventilatory failure, 3. acute decompensation of chronic respiratory insufficiency (CRI) and 4. combined failure. Considering these subgroups we obtained the best results in the group of patients with hypercapnic disturbances. In patients with hypoxemic RF we observed a success of NPPV if the improvement of CBG occurred in the early stage (< or = 12 hours) of NPPV. CONCLUSION: Our data indicate that application of NPPV is an effective and safe alternative to endotracheal intubation in many patients with hypercapnic ventilatory failure. NPPV is also successful in patients with hypoxemic RF with a milder course.

Acute Disease↗

PubMed1997

[New therapy aspects of chronic respiratory insufficiency].

The therapy of chronic respiratory insufficiency has been extended in the last years. Additional to long-term oxygen therapy nasal CPAP-therapy and home mechanical ventilation have been introduced. The different kinds of therapy are the results of different pathophysiologic alterations in the different forms of chronic respiratory insufficiency. In parenchym diseases of the lung with hypoxemic respiratory insufficiency the hypoxemia is treated by increasing the inspiratory oxygen concentration. Ventilatory pump failures can be divided in 3 large groups: respiratory muscle fatigue, central alveolar hypoventilation and recidive pharyngeal obstruction during sleep. The therapeutic principles are relieving of the respiratory muscles by intermittent assisted or better controlled mechanical ventilation in muscle fatigue, securing the alveolar ventilation by controlled mechanical ventilation in central alveolar hypoventilation and pneumatic splinting of the pharyns by nasal CPAP in obstructive sleep apnoe.

Diagnosis, Differential↗

PubMed1997

[6 minute walking test as stress test for patients treated by intermittent self-ventilation].

BACKGROUND: Until now there are no data about the exercise capacity of patients with chronic ventilatory pump failure before and during IPPV. PATIENTS AND METHODS: 55 patients with chronic ventilatory failure-20 patients before IPPV, 35 patients during mechanical ventilation with a mean of 16.5 months-were studied by the six-minute walking test. Eight patients were sampled in a follow-up study before and during IPPV with a mean of 2 months. RESULTS: The median walking distance was reduced to 273 in. The exercise capacity of the follow-up patients was not improved. The arterial pO2 during exercise fell markedly, arterial pCO2 increased only moderate. CONCLUSION: The exercise capacity of patients with chronic ventilatory failure is markedly reduced. Because of the significant oxygen desaturation on exercise we may frequently indicate ambulatory oxygen therapy.

Adult↗

PubMed1997

[Patient-related rejection of nasal IPPV therapy. Patients, reasons, follow-up].

PATIENTS: We retrospectively analysed the course of 33 patients who had rejected nasal IPPV-therapy (1988 to February 1996). RESULTS: The death-rate was higher (48%) compared to nasal IPPV patients in the same time (18%). The patients were divided in 3 main diagnostic groups (COPD, restrictive thoracic wall, neuromuscle disease). We observed the highest death-rate in COPD patients (66%) and the lowest death-rate in the group with scoliosis or chest wall disease (23%). This is the same result tendencially as in patients with nasal IPPV (mortality-rate COPD 66%, restrictive chest wall 6%).

Adult↗

PubMed1997

Native pulmonary muscular proliferation.

Four cases with native pulmonary muscular proliferation (NPMP) are reported. The etiology of this rare condition is unknown. A hamartomatous process is discussed. In spite of its rarity the correct diagnosis of this condition is important. Both clinically and histologically in transbronchial biopsies, NPMP may be mistaken for pulmonary lymphangioleiomyomatosis (PLAM). Distinction of these 2 conditions is adamant, as PLAM has a poor prognosis, and, moreover may be associated with general disease, as with tuberous sclerosis. Whereas the typical distribution of more mature desmin positive muscle cells in a dense center core and more immature desmin negative radiating peripheral muscle cell proliferation with fascicular pattern in NPMP may be recognized in open lung biopsy, these differences may not become evident in small transbronchial biopsies. Immunohistochemical methods play an important role in the differential diagnosis--as with PLAM estrogen and progesterone receptors may be expressed and, most importantly, the reaction of the HMB45-antibody appears consistently positive in muscle cells of PLAM, while negative with NPMP. Thus, recognition of this clinically innocent disease is also possible in small tissue particles.

Actins↗

PubMed1996

[Noninvasive intermittent ventilation. A prospective data collection in patients with hypoventilation syndrome].

INTRODUCTION: Noninvasive intermittent ventilation is usually performed in patients with severe ventilatory pump disorder. From 1988 to 3/1995 we treated 163 patients with the aim of home mechanical ventilation (HMV). PATIENTS AND RESULTS: In March 1993 115 of these 163 patients practiced HMV, 22 had already died and 26 had rejected or broken off ventilation therapy. The 115 patients were classified in three main diagnostic groups: Scoliosis or chest wall disease (n = 76), COPD (n = 11) and neuromuscular disease (n = 28). The mean pCO2 at rest of all patients before ventilation therapy was 56 (+/- 12) Torr and fell to 46 (+/- 5) Torr in the course of therapy. The maximum statical inspiration pressure PImax rose from average 3, 8 (+/- 2, 3) to 4, 9 (+/- 2, 0) kPa. There was a probability of surviving two years after onset of ventilation therapy of 85% in the scoliosis group, of 60% in the neuromuscular group and of 30% in the COPD group. CONCLUSIONS: According to results of others home ventilation therapy was very successful in patients with chest wall disease. In some patients with neuromuscular disorder quality of life could be improved and life prolonged. Only half of the COPD patients could be treated successfully, whereas the other half had no benefit from noninvasive ventilation therapy.

Adolescent↗

PubMed1996

[Perioperative use of noninvasive ventilation].

BACKGROUND AND AIM: Noninvasive mask ventilation is in some cases of respiratory failure the treatment of choice. It is used in cases of acute respiratory failure. We report about perioperative application of noninvasive mask ventilation. PATIENTS AND METHODS: We treated 25 patients with respiratory failure pre- and/or postoperative with noninvasive mask ventilation. RESULTS: The success rate in all patients was 68%, but it was very different in respect to the varying causes of respiratory failure. CONCLUSION: With noninvasive mask ventilation it is possible to avoid in some patients with acute postoperative respiratory failure complications who are referred to intubation. In patients with postoperative decompensation of chronic respiratory failure postoperative treatment becomes easier, in extraordinary cases the method makes surgery possible.

Humans↗