F Hinder

Publications of F Hinder

• Non-return valves do not prevent backflow and bacterial contamination of intravenous infusions.

  Authors: B Ellger, D Kiski, E Diem, I van den Heuvel, H Freise, H Van Aken, F Hinder, A W Friedrich

  The Journal of hospital infection. 03/2011; 78(1):31-5.

  Non-return valves (NRVs) are designed to avoid backflow of infusion fluid against the designated direction of flow (DDF) when more than one infusion is delivered via one venous access. We tested inNon-return valves (NRVs) are designed to avoid backflow of infusion fluid against the designated direction of flow (DDF) when more than one infusion is delivered via one venous access. We tested in vitro whether NRVs reliably prevent flow against the DDF at clinically relevant low flow rates. Since catheter-related infections caused by the infusion of contaminated fluids represent a relevant problem in patient care, we tested whether NRVs preclude bacterial contamination of infusions proximal to the NRVs and thus might play a role in preventing healthcare-associated infections. Additionally, the incidence of bacterial contamination of drips and infusion fluids in our intensive care unit (ICU) was quantified. In vitro, a low flow against the DDF of ten examples each of five different NRV models was applied and the integrity for fluid and transmigration of three different indicator micro-organisms was tested. Second, we investigated whether contamination of intravenous infusion tubing collected from patients treated on our ICU occurred. Largely independent from the model, 40% of the tested NRVs were not leak-tight for fluids when a pressure against the DDF was built up slowly. In 30%, bacteria migrated against the DDF and were detected proximal to the valve. In 6.7% of the tubing samples collected from ICU patients we detected bacterial contamination. In conclusion, contamination of drips is a relevant problem on ICU. NRVs neither reliably prevent backflow of fluids nor serve as micro-organism filters. Therefore they cannot be recommended as a way of reducing healthcare-associated infections.

• Changing from a specialized surgical observation unit to an interdisciplinary surgical intensive care unit can reduce costs and increase the quality of treatment.

  Authors: T Volkert, F Hinder, B Ellger, H Van Aken

  European journal of anaesthesiology. 06/2008; 25(5):382-7.

  BACKGROUND AND OBJECTIVES: In Germany there is considerable variability in the organizational forms of intensive-care medicine. We present economical data that arose during the reorganization of anBACKGROUND AND OBJECTIVES: In Germany there is considerable variability in the organizational forms of intensive-care medicine. We present economical data that arose during the reorganization of an intensive care unit with the implementation of the continuous presence of a trained intensivist. The unit was changed from an intensive-observational unit managed by four surgical departments without continuous presence of a trained intensivist to an interdisciplinary surgical intensive care unit managed by the Department of Anaesthesia in co-operation with the surgical departments with the continuous presence of trained intensivists. METHODS: Measurement of costs for personnel, medical equipment and external services, revenues, length of hospital stay and complications of cardiac surgical patients. RESULTS: Per year costs for personnel increased by approximately euro240,000, while expenses for medical equipment were reduced by euro245,000. In all, 466 hospital days were saved by the reduction in the length of hospital stay, providing capacity for 22 additional cardiac surgical cases. In addition, the presence of trained intensivists made it possible to provide care for more severely ill patients, which gained approximately 100 additional case-mix points and increased the hospital's revenues by more than euro300,000. Emergency readmission to the intensive care unit was reduced by 17%. The number of patients requiring renal replacement therapy and those developing non-occlusive mesenteric ischaemia was substantially reduced. CONCLUSION: In addition to the medical advantages, staffing the intensive care unit with trained intensivists 24 h a day was of appreciable economical benefit.

• [Evidence-based infection control methods using spa genotyping for MRSA spread in hospitals]

  Authors: A Mellmann, A W Friedrich, F Kipp, F Hinder, U Keckevoet, D Harmsen

  Deutsche medizinische Wochenschrift (1946). 07/2005; 130(22):1364-8.

  BACKGROUND AND OBJECTIVE: Isolation of methicillin resistant Staphylococcus aureus (MRSA) often implies rigorous infection control measures. The use of rapid and accurate typing is required toBACKGROUND AND OBJECTIVE: Isolation of methicillin resistant Staphylococcus aureus (MRSA) often implies rigorous infection control measures. The use of rapid and accurate typing is required to monitor their spread. Prompt identification of epidemic MRSA is crucial to control an outbreak, in order to avoid unnecessary interventions in patients and staff. In this study we evaluated protein A ( spa) gene repeat sequence analysis for MRSA typing in a hospital. METHODS: In 2003, all non-replicate MRSA-strains from staff and patients admitted to the University Hospital Münster (1480 beds), Germany, were spa typed. The spa types were assigned using the Ridom StaphType software. Typing results were correlated with the epidemiological findings of each MRSA isolate. RESULTS: Assignment of spa types was possible for all 175 MRSA isolates and provided rapid (mean, 2 days) typing results. spa typing method yielded 34 spa types. Synchronizing the sequencing results with a central database (http://www.spaServer.ridom.de) created a reproducible and uniform nomenclature for easy intra- and inter-hospital comparisons. CONCLUSION: spa typing makes continuous and fast MRSA typing possible for hospital isolates. The differentiation between outbreaks and accidental accumulations due to imported MRSA was easily possible and allowed implementation of focused and evidence-based infection control measures.

• Thoracic, but not lumbar, epidural anesthesia improves cardiopulmonary function in ovine pulmonary embolism.

  Authors: U R Jahn, R Waurick, H Van Aken, F Hinder, M Booke, H G Bone, C Schmidt, J Meyer

  Anesthesia and analgesia. 01/2002; 93(6):1460-5, table of contents.

  We hypothesized that sympathetic stimulation is the main mechanism contributing to hemodynamic failure in pulmonary embolism. We investigated the effects of epidural anesthesia-induced sympatheticWe hypothesized that sympathetic stimulation is the main mechanism contributing to hemodynamic failure in pulmonary embolism. We investigated the effects of epidural anesthesia-induced sympathetic blockade, restricted to thoracic and lumbar levels, during pulmonary embolism. Two experiments were performed in chronically instrumented ewes. In the first experiment, six sheep received 6 mL bupivacaine 0.175% (Thoracic Epidural Anesthesia [TEA] group), and six sheep received 6 mL saline 0.9% (TEA-Control group), respectively, via an epidural catheter (T3 level). In the second experiment, six sheep received 2.8 mL bupivacaine 0.375% (Lumbar Epidural Anesthesia [LEA] group), and six sheep received 2.8 mL saline 0.9% (LEA-Control group) epidurally (L4 level). Embolization was performed by IV injection of autologous blood clots (Experiment 1, 0.75 mL/kg; Experiment 2, 0.625 mL/kg). TEA was associated with significantly slower heart rates, decreased mean pulmonary artery pressures and central venous pressures, and significantly higher stroke volume index and oxygenation in comparison with the TEA-Control group. By contrast, LEA was associated with significantly faster heart rates and increased central venous pressures and with a significantly lower stroke volume index in comparison with the LEA-Control group. TEA significantly reduced, and LEA significantly increased, hemodynamic deterioration, suggesting beneficial effects of TEA on cardiopulmonary function during pulmonary thromboembolism. IMPLICATIONS: Thoracic (but not lumbar) epidural anesthesia was associated with beneficial cardiopulmonary effects during experimental pulmonary thromboembolism in sheep.

• [Carotid obliteration in regional anesthesia. Can the complication rate be lowered this way?]

  Authors: M Booke, T Weber, F Hinder

  MMW Fortschritte der Medizin. 11/2001; 143(41):39-40.

• The inhibitory effect of bupivacaine on prostaglandin E(2) (EP(1)) receptor functioning: mechanism of action.

  Authors: C W Hönemann, T J Heyse, T Möllhoff, K Hahnenkamp, S Berning, F Hinder, B Linck, W Schmitz, H Van Aken

  Anesthesia and analgesia. 10/2001; 93(3):628-34.

  Prostaglandin E(2) receptors, subtype EP(1) (PGE(2)EP(1)) have been linked to several physiologic responses, such as fever, inflammation, and mechanical hyperalgesia. Local anesthetics modulate theseProstaglandin E(2) receptors, subtype EP(1) (PGE(2)EP(1)) have been linked to several physiologic responses, such as fever, inflammation, and mechanical hyperalgesia. Local anesthetics modulate these responses, which may be due to direct interaction of local anesthetics with PGE(2)EP(1) receptor signaling. We sought to characterize the local anesthetic effects on PGE(2)EP(1) signaling and elucidate mechanisms of anesthetic action. In Xenopus laevis oocytes, recombinant expressed PGE(2)EP(1) receptors were functional (half maximal effect concentration, 2.09 +/- 0.98 x 10(-6) M). Bupivacaine, after incubation for 10 min, inhibited concentration-dependent PGE(2)EP(1) receptor functioning (half-maximal inhibitory effect concentration, 3.06 +/- 1.26 x 10(-6) M). Prolonged incubation in bupivacaine (24 h) inhibited PGE(2)-induced calcium-dependent chloride currents (I(Cl(Ca))) even more. Intracellular pathways were not significantly inhibited after 10 min of incubation in bupivacaine. But I(Cl(Ca)) activated by intracellular injection of GTPgammaS (a nonhydrolyzable guanosine triphosphate [GTP] analog that activates G proteins, irreversible because it cannot be dephosphorylated by the intrinsic GTPase activity of the alpha subunit of the G protein) was reduced after 24 h of incubation in bupivacaine, indicating a G protein-dependent effect. However, inositol 1,4,5-trisphosphate- and CaCl(2)- induced I(Cl(Ca)) were unaffected by bupivacaine at any time points tested. Therefore, bupivacaine's effect is at phospholipase C or at the G protein or the PGE(2)EP(1) receptor. All inhibitory effects were reversible. We conclude that bupivacaine inhibited PGE(2)EP(1) receptor signaling at clinically relevant concentrations. These effects could, at least in part, explain how local anesthetics affect physiologic responses such as fever, inflammation, and hyperalgesia during the perioperative period.

• [Neuromonitoring--a must for the future?]

  Authors: F Hinder, R Wüsten, M Booke

  Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS. 07/2001; 36(6):368-70.

• Fat elimination from autologous blood.

  Authors: M Booke, H Van Aken, M Storm, F Fritzsche, S Wirtz, F Hinder

  Anesthesia and analgesia. 03/2001; 92(2):341-3.

  Bowl-based autotransfusion devices reduce the amount of fat found in shed blood, but cannot completely eliminate fat particles. When fat is seen on the surface of the processed blood, this bloodBowl-based autotransfusion devices reduce the amount of fat found in shed blood, but cannot completely eliminate fat particles. When fat is seen on the surface of the processed blood, this blood should be filtered with a leukocyte removal filter before retransfusion.

• Efficacy and practicability of inhaled nitric oxide and aerosolized prostaglandins.

  Authors: M Booke, F Hinder

  Intensive care medicine. 08/2000; 26(7):1015-6.

• Noradrenaline and nomega-monomethyl-L-arginine (L-NMMA): effects on haemodynamics and regional blood flow in healthy and septic sheep.

  Authors: M Booke, F Hinder, R McGuire, L D Traber, D L Traber

  Clinical science (London, England : 1979). 03/2000; 98(2):193-200.

  This prospective, non-randomized, controlled experimental study looks at the effects of N(omega)-monomethyl-L-arginine (L-NMMA) on haemodynamics, oxygen transport and regional blood flow in healthyThis prospective, non-randomized, controlled experimental study looks at the effects of N(omega)-monomethyl-L-arginine (L-NMMA) on haemodynamics, oxygen transport and regional blood flow in healthy and septic sheep, and compares these effects with those of noradrenaline (NA; norepinephrine). All sheep were chronically instrumented. Six sheep received L-NMMA (7 mg.kg(-1).h(-1)), six sheep received NA, and seven sheep received the carrier alone (0.9% NaCl). The NA dosage was continuously and individually adjusted to achieve the same increase in blood pressure as observed in matched sheep of the L-NMMA group (non-septic phase). Treatment was discontinued after 3 h. Sepsis was initiated and maintained by a continuous infusion of live Pseudomonas aeruginosa. After 24 h of sepsis, the sheep were again challenged over a treatment period of 3 h with their previously assigned drug (septic phase). During the non-septic phase of the experiment, NA and L-NMMA both caused an increase in mean arterial pressure (MAP) through vasoconstriction. Ater 24 h of sepsis, all sheep developed a hyperdynamic circulatory state. While L-NMMA caused an increase in MAP through intense vasoconstriction, NA caused MAP to increase through a further elevation of the cardiac index. The NA dosage needed was significantly higher in the septic phase compared with the non-septic phase, reflecting a reduced vascular responsiveness to catecholamines during sepsis. Renal blood flow remained unchanged during either treatment in both the non-septic and the septic phases. Nevertheless, urine output increased during NA treatment in both the non-septic and the septic phases, while L-NMMA caused urine output to increase only under septic conditions.

• Hydroxyethyl starch and blood coagulation.

  Authors: M Booke, A Sielenkämper, S Wirtz, H G Bone, F Hinder

  European journal of anaesthesiology. 10/1999; 16(9):651-2.

• [Venous paradoxical air embolism]

  Authors: M Booke, H G Bone, H Van Aken, F Hinder, U Jahn, J Meyer

  Der Anaesthesist. 05/1999; 48(4):236-41.

  Paradoxical air embolism may occur with any venous air embolism. Air may either enter the systemic circulation through a patent foramen ovale or through transpulmonary passage of air. While smallParadoxical air embolism may occur with any venous air embolism. Air may either enter the systemic circulation through a patent foramen ovale or through transpulmonary passage of air. While small venous air emboli are mostly well tolerated, even the smallest paradoxical air emboli can have fatal consequences in the systemic circulation. Therapy and prophylaxis of paradoxical air embolism equal those of venous air embolism. This is especially true, since paradoxical air embolism may not become obvious under general anesthesia. More specific therapeutic regiments, such as hyperbaric oxygenation and the infusion of perfluorocarbons, are still in an experimental stage.

• A comparison of transoesophageal echocardiographic Doppler across the aortic valve and the thermodilution technique for estimating cardiac output.

  Authors: J Poelaert, C Schmidt, H Van Aken, F Hinder, T Mollhoff, H M Loick

  Anaesthesia. 03/1999; 54(2):128-36.

  This study was undertaken in order to elucidate the differences between various planes of measurement and Doppler techniques (pulsed- vs. continuous-wave Doppler) across the aortic valve to estimateThis study was undertaken in order to elucidate the differences between various planes of measurement and Doppler techniques (pulsed- vs. continuous-wave Doppler) across the aortic valve to estimate cardiac output. In 45 coronary artery bypass patients, cardiac output was measured each time using four different Doppler techniques (transverse and longitudinal plane, pulsed- and continuous-wave Doppler) and compared with the thermodilution technique. Measurements were performed after induction of anaesthesia and shortly after arrival in the intensive care unit. Optimal imaging was obtained in 91% of the patients, in whom a total of 82 measurements of cardiac output were performed. The respective mean (SD) areas of the aortic valve were 3.77 (0.71) cm2 in the transverse plane and 3.86 (0.89) cm2 in the longitudinal plane. A correlation of 0.87 was found between pulsed-wave Doppler cardiac output and the thermodilution technique in either transverse or longitudinal plane. Correlation coefficients of 0.82 and 0.84 were found between thermodilution cardiac output and transverse and longitudinal continuous-wave Doppler cardiac output, respectively. Although thermodilution cardiac output is a widely accepted clinical standard, transoesophageal Doppler echocardiography across the aortic valve offers adequate estimations of cardiac output. In particular, pulsed-wave Doppler cardiac output in both the transverse and longitudinal plane provides useful data.

• Selective inhibition of inducible nitric oxide synthase: effects on hemodynamics and regional blood flow in healthy and septic sheep.

  Authors: M Booke, F Hinder, R McGuire, L D Traber, D L Traber

  Critical care medicine. 02/1999; 27(1):162-7.

  OBJECTIVES: To investigate the effects of S-ethylisothiourea (S-EITU) on hemodynamics, oxygen transport, and regional blood flow in healthy and septic sheep. DESIGN: Prospective, randomized,OBJECTIVES: To investigate the effects of S-ethylisothiourea (S-EITU) on hemodynamics, oxygen transport, and regional blood flow in healthy and septic sheep. DESIGN: Prospective, randomized, controlled experimental study with repeated measures. SETTING: Investigational intensive care unit at a university medical center. SUBJECTS: Eleven healthy, female adult sheep of the Merino breed, divided into a control group (n = 5) and into a group treated with S-EITU (n = 6). INTERVENTIONS: All sheep were chronically instrumented. After a 5-day recovery period, they were randomly assigned to either control or S-EITU groups. While control sheep received only saline, S-EITU was administered in increasing doses of 1, 3, and 9 mg/kg/hr over 1 hr each (nonseptic phase). After 2 days of recovery, a continuous infusion of live Pseudomonas aeruginosa (2.5 x 106 colony-forming units/min) was started in all sheep and maintained for the remainder of the experiment. After 24 hrs of sepsis, the sheep again received their assigned treatment (septic phase). In both the nonseptic and septic phases, the sheep received colored microspheres through a left atrial catheter to allow analysis of regional blood flows. All animals were autopsied at the end of the experiments, and organ probes were removed for blood flow analyses. MEASUREMENTS AND MAIN RESULTS: The administration of S-EITU caused a dose-dependent vasoconstriction in the nonseptic phase. After 24 hrs of Pseudomonas infusion, all sheep developed a hyperdynamic circulatory state, with increased cardiac indices and reduced arterial pressures and systemic vascular resistances. Oxygen extraction decreased significantly, preventing an increase in oxygen consumption, despite an increased oxygen delivery. The hyperdynamic circulation was dose dependently reversed by S-EITU, causing an increase in arterial pressure by peripheral vasoconstriction. Sheep in the control group showed a continuation of the hyperdynamic circulation. The effects of S-EITU on hemodynamics and regional blood flows were comparable under septic and nonseptic conditions. CONCLUSIONS: With the inducible form of nitric oxide synthase expressed under septic, but not under nonseptic conditions, S-EITU was expected to have vasoconstrictive properties only in the septic phase. It produced a comparable vasoconstriction during the nonseptic phase of the experiment. Thus, either S-EITU does not selectively block the inducible nitric oxide synthase in sheep, or other vasodilators besides nitric oxide play an important role in septic vasodilation.

• Role of nitric oxide in sepsis-associated pulmonary edema.

  Authors: F Hinder, H D Stubbe, H Van Aken, R Waurick, M Booke, J Meyer

  American journal of respiratory and critical care medicine. 02/1999; 159(1):252-7.

  Transient pulmonary hypertension after inhibition of nitric oxide synthase (NOS) does not alter pulmonary reflection coefficients or lymph flows in endotoxemic sheep. To test the effects ofTransient pulmonary hypertension after inhibition of nitric oxide synthase (NOS) does not alter pulmonary reflection coefficients or lymph flows in endotoxemic sheep. To test the effects of persistent pulmonary hypertension induced by N omega-nitro-L-arginine methylester (L-NAME) and of inhaled NO on pulmonary edema, 18 sheep (three groups) were chronically instrumented with pulmonary artery catheters, femoral arterial fiberoptic thermistor catheters, and tracheostomy. The awake, spontaneously breathing animals received Salmonella typhi endotoxin (lipopolysaccharide; LPS) (10 ng/kg/ min) for 28 h. After 24 h, an airflow of 6 L/min was delivered through the tracheostomy. One group of animals (L-NAME/air) received L-NAME intravenously (25 mg/kg + 5 mg/kg/h) and breathed air. The second group (L-NAME/NO) was given L-NAME and NO (40 ppm) was added to the airflow. The third group was given NaCl 0.9% and breathed air (NaCl/air). Extravascular lung water was measured through the double-indicator dilution technique. Endotoxemia caused pulmonary edema, which was aggravated by L-NAME. Breathing of NO normalized pulmonary artery pressure (Ppa) and ameliorated pulmonary edema. Inhalation of NO may therefore be a therapeutic option for pulmonary edema associated with pulmonary hypertension.

• Assessment of cardiovascular volume status by transoesophageal echocardiography and dye dilution during cardiac surgery.

  Authors: F Hinder, J I Poelaert, C Schmidt, A Hoeft, T Möllhoff, H M Loick, H Van Aken

  European journal of anaesthesiology. 11/1998; 15(6):633-40.

  Conventional evaluation of cardiovascular volume status by filling pressures is unreliable in critically ill patients. Measurements of left ventricular end diastolic area index by transoesophagealConventional evaluation of cardiovascular volume status by filling pressures is unreliable in critically ill patients. Measurements of left ventricular end diastolic area index by transoesophageal echocardiography and of intrathoracic blood volume index by dye indicator dilution are new approaches to this problem. In this study, different indices of cardiovascular volume status were analysed to define their relation during the pronounced haemodynamic changes associated with systemic inflammation after cardiopulmonary bypass. Correlations were performed with left ventricular end diastolic area index, intrathoracic blood volume index, central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP). Data from 15 patients receiving coronary artery bypass grafts were compared after induction of anaesthesia and in the intensive care unit. Spearman's correlation coefficient for perioperative absolute changes in left ventricular end diastolic area index and intrathoracic blood volume index was 0.87 (P < 0.05). However, an increase in intrathoracic blood volume index by 125 mL m-2 was necessary to maintain a baseline left ventricular end diastolic area index. Absolute values of all variables varied widely, with the only significant correlation found between CVP and PCWP. Changes in CVP and PCWP did not correlate with changes in left ventricular end diastolic area index or intrathoracic blood volume index. Provided simultaneous baseline measurements are available and a supranormal intrathoracic blood volume index compensates for the haemodynamic changes in systemic inflammation, left ventricular end diastolic area index and intrathoracic blood volume index may substitute for each other during the evaluation of cardiovascular volume status in patients with stable cardiac function.

• Endogenous nitric oxide and the pulmonary microvasculature in healthy sheep and during systemic inflammation.

  Authors: F Hinder, J Meyer, M Booke, J S Ehardt, J R Salsbury, L D Traber, D L Traber

  American journal of respiratory and critical care medicine. 06/1998; 157(5 Pt 1):1542-9.

  Nitric oxide (NO) influences microvascular integrity. NO synthase inhibitors are regarded as therapeutic options, but their impact on the pulmonary microvasculature is not well defined. We studiedNitric oxide (NO) influences microvascular integrity. NO synthase inhibitors are regarded as therapeutic options, but their impact on the pulmonary microvasculature is not well defined. We studied the microvascular effects of the nonselective NO synthase inhibitor N(omega)-nitro L-arginine methylester (L-NAME) in healthy sheep and during systemic inflammation. Permeability analysis was performed in 30 adult ewes with chronic lung lymph fistulas and pulmonary venous occluders. Experiment 1: 20 sheep received Escherichia coli endotoxin (lipopolysaccharide, 10 ng/kg/min) for 32 h. After 24 h of endotoxemia, 10 sheep were given L-NAME (25 mg/kg), and 10 sheep received NaCl 0.9%. Experiment 2: six sheep were treated with L-NAME (25 mg/kg), and four animals received NaCl 0.9%. Endotoxin induced a phasic pulmonary microvascular response with early transiently increased endothelial permeability at 4 h and late normalization of microvascular integrity to large molecules after 24 h. At that time systemic vasodilation had occurred. L-NAME raised pulmonary artery pressure and pulmonary vascular resistance index without signs of increased permeability in either experiment. NO is involved in vascular tone in healthy sheep and during systemic inflammation, but it does not seem to play a role in the integrity of the pulmonary microvascular barrier function to large molecules.

• Inhaled prostaglandin E1 for treatment of acute lung injury in severe multiple organ failure.

  Authors: J Meyer, G Theilmeier, H Van Aken, H G Bone, H Busse, R Waurick, F Hinder, M Booke

  Anesthesia and analgesia. 05/1998; 86(4):753-8.

  Acute lung injury is characterized by hypoxemia due to pulmonary ventilation/perfusion-mismatching. I.v. administered prostaglandin E1 (PGE1), a vasodilator with a high pulmonary clearance, has beenAcute lung injury is characterized by hypoxemia due to pulmonary ventilation/perfusion-mismatching. I.v. administered prostaglandin E1 (PGE1), a vasodilator with a high pulmonary clearance, has been studied in acute lung injury. Inhalation of the vasodilators nitric oxide and prostacyclin improved oxygenation by selective dilation of the pulmonary vasculature in ventilated lung areas. In the present study, PGE1 inhalation was used for treatment of acute lung injury. Fifteen patients with acute lung injury defined as PaO2/fraction of inspired oxygen (FIO2) <160 mm Hg were treated with PGE1 inhalation in addition to standard intensive care. The drug was continuously delivered via a pneumatic nebulizer. Acute physiology and chronic health evaluation system II and multiple organ failure scores were (mean +/- SEM) 33 +/- 2 and 10 +/- 0.3, respectively. Inhaled PGE1 was administered for 103 +/- 17 h at a dose of 41 +/- 2 microg/h. The PaO2/FIO2 ratio increased from 105 +/- 9 to 160 +/- 17 mm Hg (P < 0.05) and to 189 +/- 25 mm Hg (P < 0.05) after 4 h and 24 h, respectively. PGE1 inhalation decreases in mean pulmonary artery pressure and central venous pressure were not statistically significant. Mean arterial pressure, pulmonary capillary wedge pressure, cardiac output, and heart rate remained unchanged. Intensive care unit mortality was 40%. The present data suggest that inhaled PGE1 is an effective therapeutic option for improving oxygenation in patients with acute lung injury. Whether inhaled PGE1 will increase survival in acute lung injury should be investigated in a controlled prospective trial. Implications: In patients with severe acute lung injury and multiple organ failure, inhaled prostaglandin E1 improved oxygenation and decreased venous admixture without affecting systemic hemodynamic variables. Controlled clinical trials are warranted.

• Nitric oxide and endothelial permeability.

  Authors: F Hinder, M Booke, L D Traber, D L Traber

  Journal of applied physiology (Bethesda, Md. : 1985). 01/1998; 83(6):1941-6.

  Nitric oxide synthase inhibition reverses systemic vasodilation during sepsis but may increase endothelial permeability. To assess adverse effects on the pulmonary vasculature, 12 sheep wereNitric oxide synthase inhibition reverses systemic vasodilation during sepsis but may increase endothelial permeability. To assess adverse effects on the pulmonary vasculature, 12 sheep were chronically instrumented with lung lymph fistulas and hydraulic pulmonary venous occluders. Escherichia coli endotoxin (lipopolysaccharide; 10 ng . kg-1 . min-1) was continuously infused for 32 h. After 24 h, six animals received 25 mg/kg of Nomega-nitro-L-arginine methyl ester (L-NAME), and six received saline. All sheep developed a hyperdynamic circulatory response and elevated lymph flows by 24 h of lipopolysaccharide infusion. L-NAME reversed systemic vasodilation, increased pre- and postcapillary pulmonary vascular resistance index, pulmonary arterial pressure, and, transiently, effective pulmonary capillary pressure. Lung lymph flows were not different between groups at 24 h or thereafter. Calculated as changes from baseline, however, lung lymph flow was higher in the L-NAME group than in the control animals, with a trend toward lower lymph-to-plasma protein concentration ratio at 25 h. Permeability analysis at 32 h by the venous occlusion technique showed normal reflection coefficients and elevated filtration coefficients without differences between groups. Reversal by L-NAME of the systemic vasodilation during endotoxemia was associated with high pulmonary vascular resistance without evidence of impaired pulmonary endothelial barrier function.

• Inhaled nitric oxide and pulmonary edema formation.

  Authors: M Booke, H Van Aken, R Waurick, F Hinder, J Meyer, D L Traber

  Critical care medicine. 01/1998; 25(12):2066.