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Biomedical subjects

T Prien

Publications and source records attributed to T Prien.

36 records · Page 2Linked to original sources
PubMed1988

Toxic smoke compounds and inhalation injury--a review.

Although the role of inhalation injury in contributing to the mortality of burn patients has received increasing attention, the available information on the toxic and injurious effects of smoke generated from uncontrolled fires is scarce. This is because each fire generates its own variety of smoke, depending on the nature of the combusting materials and the burning conditions. This review summarizes the actions of the primary smoke components, heat, particulate materials, asphyxiants (carbon monoxide and hydrogen cyanide), and pulmonary irritants, without covering the whole field of smoke toxicity. In addition, emergency measures to counteract carbon monoxide and hydrogen cyanide poisoning are discussed.

Carbon↗
PubMed1988

[The Doppler palm test].

In 384 hands the patency of the arterial arch was investigated by means of both the Allen test and the Doppler palmar arch test as developed by the authors. While the Allen test is purely subjective and gives a high proportion of false results especially in shocked patients, the Doppler palmar arch test is based on two objective criteria: 1. Demonstration of reversed flow in the distal section of the radial artery on proximal compression. 2. Demonstration of pulsatile flow in the radial thumb artery even on compression of the radial artery. The Doppler palmar arch test eliminates all negative aspects of the Allen test and is therefore definitely more reliable than the latter. It is easy to perform for investigators having little experience with Doppler sonography. The time consumed is not greater than with the Allen test.

Arteries↗
PubMed1988

Cardiopulmonary responses to continuous administration of endotoxin.

The cardiopulmonary response to continuous administration of lipopolysaccharide (LPS) was studied in chronically instrumented sheep. LPS was administered in doses of 0 (sham), 6, 9, 12, and 24 ng.kg-1.h-1 for 24 h. No significant changes in the measured variables occurred in the sham group and in the 6 ng.kg-1.h-1-LPS group. With 9, 12, and 24 ng.kg-1.h-1-LPS, cardiac index rose and peripheral resistance fell to the same extent in all three groups. Lung lymph flow (QL) increased with increasing concentration of LPS. These elevations in QL occurred in the presence of only minor increases in the pulmonary artery pressure, which rose to the same extent in the 9, 12, and 24 ng.kg-1.h-1 groups. Consequently, the changes in QL were attributable to changes in fluid conductance of the pulmonary microvasculature rather than variations in hydrostatic pressure. The increase in QL correlated with a decrease in prekallikrein levels (r = 0.97), indicating that the changes in fluid conductance might have been kinin mediated.

Animals↗
PubMed1988

Haemolysis and artifactual lung damage induced by an euthanasia agent.

The artifactual development of endothelial necrosis, pulmonary congestion, and oedema that has been reported in dogs, cats, and monkeys when the animals were killed with 1-1.5 ml/kg body weight of the euthanasia agent T-61 was reproduced in adult ewes of the merino breed. This species also exhibited a marked pulmonary congestion with intra-alveolar haemorrhages, septal oedema, and a diffuse cellular damage of the alveolar septa when the recommended dose of 0.3 ml/kg body weight was administered after forcing blood flow through one lung by clamping the contralateral hilum. The red coloration of the damaged lung areas may be due to haemolysis, another aspect of T-61 induced cell damage in this species. The degree of haemolysis increases with increasing blood concentration of the agent and approximates complete haemolysis at a T-61 blood concentration of 5%. The blood concentration dependent degree of haemolysis in sheep suggests a similar relationship between blood concentration of the agent and degree of pulmonary tissue damage.

Amides↗
PubMed1987

Pulmonary edema with smoke inhalation, undetected by indicator-dilution technique.

Despite experimental evidence for an increase in extravascular lung water (EVLW) after inhalation injury, thermal-dye estimations of EVLW, extravascular thermal volume (EVTV), have repeatedly failed to demonstrate its presence in patients. This situation was evaluated in a sheep model. Under halothane anesthesia one lung was insufflated with cotton smoke and the other with air. EVTV values were 8.4 +/- 0.48 ml/kg at base line and were not elevated at 24 h after smoke inhalation (8.3 +/- 0.45 ml/kg; means +/- SE). Gravimetric analysis 24 h after smoke inhalation showed the development of edema in smoke-exposed lungs. The blood-free wet weight-to-dry weight ratio of the smoke-exposed lungs (5.4 +/- 0.32) was significantly higher compared with the contralateral unsmoked lungs (4.3 +/- 0.15; P less than or equal to 0.05). The thermal-dye technique thus underestimates EVLW. Poor perfusion of the smoke-exposed lungs 24 h after injury was demonstrated indirectly by killing a group of sheep with T-61, an agent that causes a dark red coloration of well-perfused lung areas, as well as directly by measurement of blood flow utilizing a radiolabeled microsphere technique. Thus the inability of the thermal-dye technique to detect the lung edema may be the result of poor perfusion of the injured lung.

Animals↗
PubMed1987

[Hemodynamics under propofol-nitrous oxide anesthesia: effects of premedication with lormetazepam and of additional fentanyl].

Propofol, in both its new oil-in-water emulsion and the former cremophor-EL solution, is known to produce significant decreases in arterial blood pressure. The aim of this study was to obtain a precise hemodynamic profile of anesthesia induction with propofol under conditions of daily routine (additional 70% nitrous oxide) and to evaluate the influence of (1) premedication with lormetazepam and (2) additional i.v. injection of fentanyl. Forty patients (ASA classes I and II) were randomly assigned to one of four groups (A, B, C, and D). Anesthesia was induced with a sleep dose of propofol (mean: 2.4 mg/kg) and the patient was ventilated with 30% O2 and 70% N2O via a face mask. In groups B and D, 3 micrograms/kg fentanyl were injected immediately prior to propofol injection. Patients in groups A and B received no premedication. Patients in groups C and D received 2 mg lormetazepam on the evening prior to the anesthetic and 1 mg 2 h prior to the anesthetic orally. The following parameters were determined immediately prior to induction of anesthesia and 1, 3, 5, 8, and 10 min after the start of the propofol injection: heart rate (HR), mean arterial blood pressure (MAP), mean pulmonary artery pressure (PAP), central venous pressure (CVP), pulmonary occlusion pressure (POP), cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR). In all four groups a slight decrease in HR and SVR occurred while a marked decrease in arterial blood pressure (SAP, MAP, DAP) and cardiac output was seen. PAP and preload pressures showed no significant changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1987

[Future perspectives for anesthesia induction and recovery].

The provision of separate rooms for the induction of anesthesia and the recovery phase is said to allow for a higher frequency of surgical procedures. However, the use of special rooms for the recovery phase is unnecessary from a practical and economic point of view. The availability of separate rooms for the induction of anesthesia may be important whenever the frequency of regional anesthesia is high. The induction of general anesthesia in low-risk patients can be performed in the operating room (OR) without too much delay between cases. Anesthesia in high-risk patients should be induced and reversed in the OR while problems of monitoring during transport remain unsolved.

Anesthesia, General↗
PubMed1986

[The accuracy of oxygen flowmeters].

The accuracy of oxygen flowmeters is a prerequisite for a predictable oxygen therapy. As a flowmeter seems to be of unlimited service life, they are often not serviced regularly. This can result in errors in the actual oxygen flow of as much as 50% of the preset value.

Humans↗
PubMed1984

[Brain function and artificial respiration].

Haemodynamic changes (cerebral perfusion pressure, cerebral blood flow) and variations of blood gases (especially paCO2) induced by mechanical ventilation, can influence cerebral function. The cerebral response to these changes is modified by the individual pathophysiology of the cranial contents. The cerebral mechanisms of adaptation allow a safe ventilation of a patient without cerebral disorders, provided ventilation is within normal clinical limits. In patients, however, whose mechanisms of adaption are impaired locally or globally, the pathophysiological situation may become grossly changed by variations in the ventilatory pattern. A therapeutical application of this interaction is controlled hyperventilation to lower intracranial pressure. On the other hand, changes in the ventilatory pattern (variation of PEEP-level, variation of minute volume, bronchial toilet) can impair cerebral function critically. As the individual reactions cannot be predicted in this group of patients, monitoring of haemodynamic parameters (MAP, CVP, CO), blood gases, intracranial pressure, and EEG is of utmost importance.

Acid-Base Equilibrium↗
PubMed1984

[Inhalation injury of the lung].

Because of the complex composition of smoke generated during fires and the possible combination of inhalation injury with other pulmonary complications of burns, the clinical course of inhalation injury is variable. Because clinical manifestations may be delayed several hours and furthermore are not specific, fiberoptic bronchoscopy is most appropriate in diagnosing pulmonary injury at the time of admission. Dominating pathological feature is a membraneous tracheobronchitis. Acute airway occlusion with sloughed bronchial mucosa, oedema formation and pulmonary infection are the most common complications. Treatment includes administration of oxygen, use of bronchodilators, and, when necessary, mechanical ventilation. Supplemental oxygen delivered at high concentrations will increase CO elimination and should be administered to all patients until the blood level of carboxyhaemoglobin has been measured.

Bronchoscopy↗
PubMed1983

[Analysis of contemporary and future respiratory therapy].

Up to now there are no systematics of respiratory therapy, although those procedures of "conservative" respiratory therapy are well known since the last century. As ventilation will take over a part or the whole work of breathing of a patient this kind of respiratory therapy must be separated from the conservative therapy procedure, which is the focal point of respiratory therapy. This has been demonstrated by an analysis of respiratory therapy made on two different ICU's. From this analysis a system has been developed encompassing the whole range of respiratory therapy.

Germany, West↗
PubMedDate not supplied

Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery.

The effects of intraoperative changes in plasma colloid osmotic pressure (COP) on the formation of intestinal edema were studied in patients during modified Whipple's operation (hemipancreato-duodenectomy). Eighteen patients (ASA physical status I or II) were randomly assigned to one of three groups. They received either lactated Ringer's (RL group, n = 6), 10% hydroxyethyl starch (HES group, n = 6), or 20% human albumin (HA group, n = 6) as a volume replacement solution, which was given to maintain central venous pressure (CVP) at the preoperative level. Jejunal specimens were obtained after the first transsection of the jejunum and prior to the jejuno-jejunostomy. Their water fraction (g H2O/g tissue dry weight) was measured gravimetrically. COP was determined prior to induction of anesthesia and upon removal of the second jejunal sample. In the RL group, 3,850 +/- 584 ml (data are means +/- SEM) of volume replacement solution were infused from induction of anesthesia to removal of the second jejunal sample. In the HES group, 1,358 +/- 45 ml were infused, and in the HA group, 463 +/- 49 ml were infused. During this time, COP decreased from 20.3 +/- 0.5 mmHg to 14.1 +/- 0.6 mmHg in the RL group, remained at 22.0 +/- 0.9 mmHg in the HES group, and increased from 20.7 +/- 0.9 mmHg to 28.1 +/- 0.9 mmHg in the HA group.(ABSTRACT TRUNCATED AT 250 WORDS)

Albumins↗
PubMedDate not supplied

Development of intensive care medicine in Germany.

As of 1991, intensive care medicine in Germany is not an independent medical specialty but a part of other main medical specialities such as anesthesiology, internal medicine, surgery, and pediatrics. Accordingly, there is neither formal training nor a separate board examination in intensive care medicine. As in other countries, intensive care units (ICUs) were established during the 1950s and 1960s, triggered by the positive experience with consolidation of polio victims in special respiratory care units. Surgical (or operative) ICUs predominantly are operated by anesthesiology departments, as anesthesiologists' expertise in respiratory and hemodynamic support qualifies them for the management of the critically ill patient in the perioperative phase. This article gives a brief review of the development of intensive care medicine in Germany, thereby providing the historical background for its present national and regional organization, facilities, and education and training programs.

Anesthesiology↗
PubMedDate not supplied

Lack of hematogenous mediated pulmonary injury with smoke inhalation.

Inhalation injury was studied in chronically prepared sheep (n = 12) by insufflating one lung with cotton smoke from burning cotton cloth. The contralateral lung was insufflated with air. There was also a sham group in which both lungs were insufflated with air (n = 6). The pulmonary status of the smoked animals gradually deteriorated; by 24 hours shunt blood flow had increased to 32 +/- 3% and the animals were sacrificed. Wet-weight/dry-weight ratios were elevated only in the smoke-exposed lungs. They likewise showed histologic evidence of injury. Lavage materials from the injured lungs had higher percentages of neutrophils than the others. The lung lesion produced by the inhalation of cotton smoke appears to be localized to the area of injury, rather than being a generalized pulmonary response.

Animals↗
PubMedDate not supplied

Normal phosphatidylcholine composition of lung surfactant 24 hours after inhalation injury.

The effects of cotton smoke injury on the phosphatidylcholine composition of pulmonary surfactant material were studied. While under halothane anesthesia, 18 ewes were intubated using a double-lumen tube. In six sheep the left lung was exposed to smoke; in another six sheep the right lung was exposed to smoke. A sham group of six sheep was insufflated with air instead of smoke. Twenty-four hours later the animals were killed, and alveolar lavage fluid was obtained from both lungs. Phospholipid material was separated, and its relative phosphatidylcholine composition was determined. In the smoke-treated lungs this composition was not different statistically when compared with the contralateral and the sham-exposed lungs. These findings suggested that smoke inhalation has no effect on the composition of the phosphatidylcholine fraction in the alveolar lining layer 24 hours after injury.

Animals↗