Publications (10)2.79 Total impact
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Article: Materialien und Technik der nichtinvasiven Beatmung
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ABSTRACT: Die Vielfalt der Beatmungsgeräte und der Beatmungsmodi ist nahezu unüberschaubar geworden. Versuche zur Nomenklatur und Systematik blieben unvollständig. Die hauptsächlichen Beatmungsformen bleiben die Beatmung mit Volumen- oder Druckvorgabe, wobei die Druckvorgabe die Volumenvorgabe abgelöst hat, und sich beide in sog. Hybridmodi ergänzen. Selbstlernende, kontrollierte Beatmungsmodi erweitern das Feld von assistierter, assistiert-kontrollierter und kontrollierter Beatmung. Die Auswahl des geeigneten Beatmungssystems und die optimale Einstellung erfordern ein grundlegendes Verständnis der jeweils vorliegenden Erkrankung. Je nach Erkrankung bedarf es unterschiedlicher Einstellungen von Beatmungsmodus und Beatmungsparametern. Die individuelle Einstellung der Druckaufbau- und -abbaugeschwindigkeit kann die Effizienz und Akzeptanz fördern. Die Auswahl des Zubehörs (Schlauch, Maske) inklusive einer optimalen Atemgasklimatisierung hat ebenfalls Einfluss auf die Beatmungsqualität. The variety of respirators and artificial respiration modes has almost become difficult to grasp, and attempts for a nomenclature remain incomplete. The principal modes are volume-targeted and pressure-limited ventilation. Pressure-limited ventilation has replaced volume-controlled ventilation, and both are complementary in so-called hybrid modes. Self-learning controlled ventilation modes extend the field of assisted, assisted-controlled, and controlled ventilation. The choice of a suitable ventilator system and the optimum settings requires a basic understanding of the underlying disease, which determines the different settings and parameters. Individual settings for increases and decreases in pressure can promote efficiency and compliance. The choice of accessories (tube, mask), including optimum humidification, also influences the ventilation quality. SchlüsselwörterBeatmungsgeräte-Beatmungsmaske-Volumenvorgabe-Druckvorgabe-Atemgasklimatisierung KeywordsMechanical ventilators-Interfaces-Volume-targeted-Pressure-limited-HumidifiersDer Pneumologe 04/2012; 7(2):81-88. -
Article: [Survey of nursing services with regard to mechanical ventilation at home].
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ABSTRACT: Homecare for mechanically ventilated patients is complex and challenging for homecare institutions. The framework conditions of homecare are regulated by a likewise complex social legislation. The German Respiratory Society (DGP) and the German Interdisciplinary Society for Home Care Ventilation (DIGAB) have published recommendations on the structure of homecare for ventilated patients in their recent guideline and recommended a certification of homecare nursing services. Prior to a certification process, the homecare task force of the DIGAB conducted a survey in order to compare the current structures with the guideline recommendations. Voluntary disclosure of information by means of a written questionnaire consisting of eleven items was requested. 37 homecare institutions with a total of 78 subsidiaries providing service all over Germany returned their questionnaires. While educational standards are mostly in line with the guideline recommendation, it was found that only 43 % of 812 recorded patients followed up with a specialised weaning centre or centre for ventilation. 84 % of these patients were ventilated invasively. In spite of the fact that all homecare institutions took care of invasively ventilated patients, there was a lack of company-owned standards for specific nursing measures. Homecare for ventilated patients in Germany has reached a decent degree of organisation, while follow-up with specialised centres for ventilation, and with that medical specialist care appears to be underserved. The certification process for homecare institutions should be pursued with emphasis in order to create uniform quality standards. The number of invasively ventilated patients in homecare settings is probably higher than previously estimated and could be the result of a lack of weaning capacity.Pneumologie 11/2011; 65(11):685-91. -
Article: [Polycythemia].
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ABSTRACT: Polycythemia is defined by the increase of hematocrit and haemoglobin respectively. Possible causes might be neoplastic diseases like polycythemia vera with proliferation of a cell clone. More often one will find reactive forms resulting from chronic hypoxemia. A physiologic form of polycythemia can be found in highlanders and athletes training at high altitude. With increasing frequency erytrhopoetin and it's analoga are being used as doping substances to induce Polycythemia. Red cell proliferation induced by chronic hypoxemia is the most common form in patients. In this instance the lung itself can be the cause (hypoxemia with hypocapnea in blood gas analysis) or hypoventilation caused by an insufficient respiratory pump (hypercapnea with hypoxemia in blood gas analysis) induces a compensatory Polycythemia. The former form can be treated with long term oxygen therapy and the latter by non-invasive ventilation, either approach corrects hypoxemia and reduces Polycythemia within some weeks.DMW - Deutsche Medizinische Wochenschrift 11/2010; 135(46):2300-3. · 0.53 Impact Factor -
Article: [Non-invasive and invasive mechanical ventilation for treatment of chronic respiratory failure. S2-Guidelines published by the German Medical Association of Pneumology and Ventilatory Support].
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ABSTRACT: The field of mechanical ventilation is highly important in pulmonary medicine. The German Medical Association of Pneumology and Ventilatory Support ["Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP)"] therefore has formulated these guidelines for home mechanical non-invasive and invasive ventilation. Non-invasive home mechanical ventilation can be administered using various facial masks; invasive home mechanical ventilation is performed via a tracheostomy. Home mechanical ventilation is widely and increasingly accepted as a treatment option for chronic ventilatory failure which most often occurs in COPD, restrictive lung diseases, obesity-hypoventilation syndrome and neuromuscular disorders. Essential for the initiation of home mechanical ventilation are the presence of symptoms of ventilatory failure and the detection of hypoventilation, most importantly hypercapnia. These guidelines comprise general indication criteria along with disease-specific criteria summarised by treatment algorithms. In addition, the management of bronchial secretions and care of paediatric patients are addressed. Home mechanical ventilation must be organised around a specialised respiratory care centre with expertise in patient selection, the initiation and the control of home mechanical ventilation. In this regard, the guidelines provide detailed information about technical requirements (equipment), control and settings of mechanical ventilation as well as organisation of patient care. A key requirement for home mechanical ventilation is the qualification of specialised home-care services, which is addressed in detail. Independent living and the quality of respiratory care are of highest priority in patients receiving home mechanical ventilation, since home mechanical ventilation can interfere with the integrity of a patient and often marks a life-sustaining therapy. Home mechanical ventilation has been shown to improve health-related quality of life of patients with chronic ventilatory failure. Long-term survival is improved in most patient groups, even though the long-term prognosis is often severely limited. For this reason, ethical issues regarding patient education, communication with ventilated patients at the end of life, living will, testament and medical care during the dying process are discussed.Pneumologie 04/2010; 64(4):207-40. -
Article: [Cerebral arterial gas embolism as complication during the therapeutic endobronchial use of argon plasma coagulation].
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ABSTRACT: In this case report, argon plasma coagulation (APC) was applied in a male individual to treat an occluding tumour of the right middle lobe bronchus with a post-stenotic atelectasis. During attempted recanalisation, the patient suffered a cerebral gas embolism as seen on CT scan, resulting in a distinct neurological deficit. We discuss the available data about cerebral gas embolism as a complication of APC and possibilities to avoid such complications.Pneumologie 07/2008; 62(6):353-4. -
Article: [Frequency and influence of nosocomial pathogens on weaning outcome and in-hospital mortality in mechanically ventilated patients in a regional weaning centre in comparison of the years 2002 and 2006].
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ABSTRACT: Patients with nosocomial infections in the intensive care unit (ICU) seem to have a poor prognosis. In this retrospective cohort study we investigated the relationship between weaning outcome, in-hospital mortality and the microbiological proof of nosocomial pathogens from secretions in mechanically ventilated patients in the years 2002 and 2006. 311 patients with long term (> 14 days) invasive (tube or tracheostomy) mechanical ventilation (MV) were enrolled in to the study when they had failed at least two weaning attempts prior to transfer. Microbiological proof of nosocomial pathogens from secretions sampled by the bronchoscope and an X-ray of the chest on admission day (in the transferring ICU and in our ICU) was collected from all patients. There was a significant decline of the weaning success rate between 2002 and 2006 (p = 0.001). The In-hospital mortality was higher in 2006 (p = 0.03). The microbiological proof of nosocomial pathogens had no influence on the weanability (exception: MRSA patients in 2002). In both years, patients with infiltrates on X-ray of the chest showed no increased mortality. But in 2006 it took longer to liberate these patients from invasive MV. In 2002 microbiological proof of pathogens was related to higher in-hospital mortality. In 2006, there was no difference concerning mortality in both groups. Proof of nosocomial pathogens and infiltrates had no influence on the weanability of long-term mechanically ventilated patients. For in-hospital mortality, the results are contradictory.Pneumologie 07/2008; 62(6):361-6. -
Article: [Cardiopulmonary exercise testing before and after blood donation].
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ABSTRACT: The link between haemoglobin and physical performance was established a long time ago and is the underlying principle of blood doping. Blood loss on the other hand decreases physical capacity. The aim of this study is to evaluate physical performance loss and underlying mechanisms following voluntary blood donation. Eleven voluntary subjects (four female) completed a symptom-limiting cardio-pulmonary exercise test before and after blood donation (500 mL blood). The haemoglobin value decreased by 1.2 mg/dL (9%, p < 0.001), maximal oxygen uptake by 9% (p = 0.006), maximal work rate by 13% (p = 0.001) and duration of exercise fell from 663 down to 607 seconds (p = 0.005). Anaerobic transition occurred at 81.2% and 71.5% of maximal oxygen uptake before and after blood donation, respectively (p = 0.001). Subjects who practise recreational endurance sports appear to be more effected by endurance loss. The haemoglobin value was the only significant predictor of maximal oxygen uptake in regression analysis (p < 0.001). Maximal physical performance is impaired after blood donation. Haemoglobin decline accounts for the decreased oxygen uptake. As a consequence thereof the anaerobic transition occurs earlier. Subjects not engaged in regular sports activity did not experience a decline in their capacity. Inclusion of the haemoglobin value into equations predicting maximal oxygen uptake could improve prediction precision.Pneumologie 07/2008; 62(6):372-7. -
Article: [Time-adaptive mode, a new ventilation form for the treatment of respiratory insufficiency--a self-learning system].
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ABSTRACT: Hypercapnic respiratory failure is usually caused by an overload of the respiratory muscles (respiratory pump). After treatment of the underlying disease, mechanical ventilation will achieve optimal treatment success and higher degrees of respiratory muscle unloading will improve the outcome in terms of lower PaCO (2) levels and improved exercise performance. Routinely assisted modes are being used for ventilation, where the patient has to trigger the ventilator with his effort. Controlled ventilation is usually applied in sedated patients lacking spontaneous breathing efforts that are necessary to trigger the ventilator. Controlled ventilation, however, is feasible in awake patients but requires operator expertise. In this process, the respiratory pattern of the ventilator has to be adapted to the patient's own respiratory pattern. Changing conditions require a re-adaptation of parameters. In order to automatise this complex and time-consuming operation, a time-adaptive mode (TA-mode) has been developed. This programmed mode incorporates a self-learning algorithm, primarily detecting the patient's respiratory pattern. The software then calculates a matching flow profile using a motion equation that gives consideration to resistance and compliance. The operator has to pre-select allowed ranges of parameters (especially in- and expiratory pressures, IPAP and EPAP). After detection of a stable respiratory pattern (usually after 10 - 20 breaths), the ventilator will slowly increase the calculated flow profile and achieve controlled ventilation without irritating respiratory centres of the brain. Respiratory drive will cease usually within three to five minutes. Restart of the respiratory drive, for example, after coughing or during REM sleep with an altered respiratory pattern will be detected as ventilator fighting and the programme will return to the analysis algorithm again. After the respiratory pattern has become stable, the ventilator will take over ventilation again. The new mode has been validated in an accreditation study. For this purpose we selected 21 patients with stable hypercapnic respiratory failure, most of whom (20) had previously been ventilated with a controlled T-mode and only one patient had previously been ventilated with an assisted mode and adapted them to the new ventilator under polygraphic surveillance. Each time seven patients were adapted to a T-, ST- and TA-mode, respectively. Two patients, however, could not be adapted to ST-mode ventilation and were switched to TA-mode. PCO (2) values before and after ventilation were not significantly different between modes. Patient satisfaction was rated very good in 34 %, good in 45 % and non-gratifying in 21 % of cases ventilated with TA-mode. Consideration has to be given to the fact that patients previously had been receiving optimal ventilator treatment. The TA-mode is a self-learning system, capable of copying the patients own breathing pattern while awake, in order to achieve complete unloading of the respiratory muscles through controlled ventilation during a circumscribed period.Pneumologie 05/2008; 62(9):527-32. -
Article: [Expiratory pressure reduction (C-Flex Method) versus fix CPAP in the therapy for obstructive sleep apnoea].
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ABSTRACT: The REM star C-Flex (Fa. Respironics) was introduced in 2003. In contrast to the conventionel fix CPAP mode, the C-Flex mode is characterised by a pressure reduction at the beginning of expiration. In a randomised cross-over design, we investigated if this C-Flex-mode has advantages compared to the fix CPAP mode in terms of treatment quality and patient satisfaction. In this prospective randomised single-blinded cross-over study we investigated 20 patients with obstructive sleep apnoea treated with fix CPAP versus treatment with the C-Flex mode (level 2) for 6 weeks, respectively. We compared the polysomnographically measured quality of treatment and the subjective satisfaction of either form of therapy. Additionally, we measured long-term compliance of the C-Flex therapy in a 3-year follow-up with the integrated counter of the C-Flex devices. The mean levels of pressure of the fix CPAP and the C-Flex therapies were 8.4 +/- 2.9 mbar in both groups. There was an identical quality of treatment in terms of respiratory events, arousal index, slow wave sleep and Epworth sleepiness scale. The compliance of nocturnal use of the C-Flex and the fix CPAP was identical (6.0 +/- 0.67 C-Flex use vs. 5.8 +/- 0.98 CPAP use [h/night]). The subjective satisfaction was higher in the C-Flex mode at the end of the study since 18 of 20 patients (90%) subjectively prefered the C-Flex mode because of the easier expiration. 19 patients received a C-Flex device for long-term therapy. The 3-year-follow-up showed a regular utilisation of the C-Flex by 16 of 19 (84.2%) of these patients (mean nocturnal use 6.0 +/- 0.9 h/night). 3 of the 19 patients (15.8%) did not use their C-Flex regulary. None of the patients has terminated therapy completely. C-Flex mode and the conventional fix CPAP therapies show an equivalent treatment quality according to polysomnographic data. The expiratory pressure reduction compared to conventional CPAP was felt to be more comfortable by 90% of patients. The long-term-compliance as measured by regular use of the C-Flex device was 84.2% (16 out of 19 patients) after 3 years, these numbers are higher than published data on compliance with conventional CPAP therapy.Pneumologie 12/2007; 61(11):692-5. -
Article: Long-term oxygen therapy stops the natural decline of endurance in COPD patients with reversible hypercapnia.
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ABSTRACT: Respiratory muscle weakness is one of the most important causes of hypercapnia in patients with COPD. There is evidence that stable hypercapnic patients will benefit from long-term oxygen therapy (LTOT). The prognostic role of reversible hypercapnia in COPD is still unclear. Early implementation of LTOT in these patients may influence endurance time and mortality. In this pilot study, we investigated 28 patients (26 males, 49-74 years) with COPD, advanced airflow limitation [forced expiratory volume in 1 s (percentage of predicted value) 40.8 +/- 10.2] and mild hypoxaemia (pO(2) 66.5 +/- 6.3 mm Hg). All patients had developed a moderate reversible hypercapnia during an acute exacerbation or during exercise testing (peak pCO(2) 48.0 +/- 2.5 mm Hg). Patients were allocated randomly to a control group (n = 14) or an LTOT group (n = 14). The two groups were well matched in terms of physiological data. Lung function, endurance time (cycle ergometer), dyspnoea score, blood gases and LTOT compliance were measured at baseline and every 6 months over a period of 3 years. Endurance time increased from 6.4 +/- 2.7 min at baseline to 7.1 +/- 2.7 min after 1 year in the LTOT group and decreased from 6.1 +/- 3.0 to 4.9 +/- 3.8 min in the controls (p < 0.05). After 1 year, the end-exercise dyspnoea score was significantly lower in the LTOT group (4.5 +/- 1.5) than in the controls (5.7 +/- 1.9). COPD patients with reversible hypercapnia and mild hypoxaemia benefit from LTOT in terms of endurance time and a reduction of exertional dyspnoea after 1 year.Respiration 71(4):342-7. · 2.26 Impact Factor
