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ABSTRACT: Es wird über eine 77-jährige Patientin berichtet, die bewusstlos mit engen Pupillen und Bradypnoe aufgefunden wird. Vorausgegangen
waren Schwindel, Übelkeit und Schläfrigkeit. In der Klinik findet sich ein Fentanyl-Pflaster auf der Haut, das sich die Patientin
offenbar im Rahmen einer Verwechslung selber am Vortag appliziert hat. Es wird nun die Diagnose “Opioidintoxikation” gestellt,
mit Naloxon antagonisiert und die Patientin 24 h überwacht, bevor sie symptomfrei nach Hause entlassen wird. Die Folgen eines
fehlerhaften Umgangs mit transdermal appliziertem Fentanyl werden diskutiert.
The case of a 77-year-old woman is described, who was found unconscious, with decreased respiration and miotic pupils, having
previously experienced dizziness, nausea and drowsiness before. In the emergency room a fentanyl patch was detected, which
had obviously been mistakenly applied by the patient the day before. Opioid intoxication was assumed and successfully treated
with naloxon. The patient was supervised in an ICU for 24 h and sent home the next day without serious sequelae. The consequences
following inappropriate use of transdermal fentanyl are discussed.
Der Anaesthesist 04/2012; 51(4):269-271. · 0.99 Impact Factor
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ABSTRACT: Blind insertion of endotracheal tubes through the intubating laryngeal mask airway (ILMA) is unsuccessful in almost 50% of cases on the first attempt, with an overall success rate of approximately 90%. We used a portable fiber optic device (Foley Airway Stylet Tool® FAST) to detect the reasons for failed intubations and tested its use in facilitating endotracheal tube placement.
Thirty patients without anticipated intubation difficulties participated in the study. The fiber optic device was fastened with its tip at the end of the endotracheal tube, and both instruments were advanced through the previously inserted ILMA past the lifting bar. The view was scored in the following manner: I, full view of laryngeal inlet; II, partial vocal cords, arytenoids, epiglottis; III, epiglottis; IV, no laryngeal structures identifiable. The ILMA was adjusted for the best obtainable view, which was scored, and the endotracheal tube was inserted.
The initial laryngeal view was I in four patients, II in eighteen patients, III in one patient and IV in seven patients. The best view after corrective maneuvers was I in twenty-seven patients, II in two patients and IV in one patient. First attempt tracheal intubations were successful in twenty-seven (90%) patients; two patients required a second attempt.
A grade II view or worse indicated misalignment of the ILMA with the glottis. An endotracheal tube inserted blindly through the misaligned ILMA will impinge on and potentially damage laryngeal structures. The use of a portable fiber optic device can help reduce the failure rate of endotracheal intubations by utilizing ILMA in emergent situations.
Minerva anestesiologica 05/2011; 77(11):1037-42. · 2.66 Impact Factor
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ABSTRACT: The serotonin syndrome is caused by a drug-induced increase of the intrasynaptic serotonin concentration. Milder forms of the syndrome may be difficult to diagnose because of the variability of symptoms. Severe forms often rapidly turn into a life-threatening situation, therefore the serotonin syndrome may be a challenge for physicians. We describe the pathophysiology and therapeutic options of the serotonin syndrome and report about a 42-year-old female patient who ingested large amounts of moclobemide, a monoamine oxidase inhibitor, and citalopram, a selective serotonin reuptake inhibitor, for attempted suicide. Within a few hours the patient developed a lethal serotonin syndrome although ICU therapy was initiated immediately.
Der Anaesthesist 12/2006; 55(11):1189-96. · 0.99 Impact Factor
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ABSTRACT: The purpose of this study is to evaluate the demographic characteristics of patients who suffered cardiac arrest in our intensive care units (ICUs) as well as to identify those factors influencing outcome after resuscitation following cardiac arrest.
We reviewed the records of all patients who underwent cardiopulmonary resuscitation (CPR) in our ICUs at the Georg-August University Hospital, Goettingen, Germany, from January 1, 1999 to December 31, 2003.
One hundred and sixty-nine patients underwent CPR. Severity of illness assessed by SAPS II score on admission was 51.8+/-18.5 (predicted mortality 46.6%). The initially monitored rhythm at the time of arrest was asystole in 51 (30.2%) patients. Ventricular tachycardia/fibrillation (VT/VF) was recorded in 65 (38.5%) and pulseless electrical activity in 49 (29.0%) patients. Twenty (23.8%), 28 (33.3%) and 33 (39.3%) patients with initially recorded asystole, VT/VF and pulseless electrical activity (PEA) rhythms, respectively, survived to ICU discharge. Eighty of the 169 patients survived to hospital discharge giving a survival rate of 47.3%. The highest ICU mortality was seen in patients admitted for neurosurgery (80%) followed by major vascular surgery (77.8%), non-surgical patients (67.4%) and patients with severe sepsis (66.7%). The occurrence of cardiac arrest within the first 24h was associated with a significantly lower ICU mortality compared to a later incident. At hospital discharge 66 patients (82.5% of the survivors) achieved good cerebral recovery, 12 patients (15.0%) were severely disabled (CPC 3) while 2 (2.5%) remained unconscious.
Several factors affect the outcome from CPR. However, quicker triage to ICU, closer monitoring along with prompt intervention might minimise the consequences of cardiac arrest and its complications.
Resuscitation 12/2006; 71(2):161-70. · 3.60 Impact Factor
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ABSTRACT: Das Serotoninsyndrom wird durch einen medikamentös-induzierten, exzessiven Anstieg der intrasynaptischen Serotoninkonzentration ausgelöst und stellt eine Herausforderung für die behandelnden Ärzte dar. Leichte Fälle können aufgrund der Variabilität der einzelnen Symptome übersehen werden, während schwere Fälle sich innerhalb kürzester Zeit zu einem lebensbedrohlichen Krankheitsbild entwickeln können. Im Folgenden wird über eine 42-jährige Patientin berichtet, die in suizidaler Absicht größere Mengen des Monoaminooxidasehemmers Moclobemid und des selektiven Serotonin-Wiederaufnahmehemmers Citalopram eingenommen hatte und im Verlauf das Vollbild eines therapierefraktären, tödlichen Serotoninsyndroms entwickelte. Anschließend werden die Pathophysiologie und mögliche Therapieoptionen dieses Krankheitsbildes dargestellt.
Der Anaesthesist 10/2006; 55(11):1189-1196. · 0.99 Impact Factor
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ABSTRACT: Das Serotoninsyndrom wird durch einen medikaments-induzierten, exzessiven Anstieg der intrasynaptischen Serotoninkonzentration ausgelst und stellt eine Herausforderung fr die behandelnden rzte dar. Leichte Flle knnen aufgrund der Variabilitt der einzelnen Symptome bersehen werden, whrend schwere Flle sich innerhalb krzester Zeit zu einem lebensbedrohlichen Krankheitsbild entwickeln knnen. Im Folgenden wird ber eine 42-jhrige Patientin berichtet, die in suizidaler Absicht grere Mengen des Monoaminooxidasehemmers Moclobemid und des selektiven Serotonin-Wiederaufnahmehemmers Citalopram eingenommen hatte und im Verlauf das Vollbild eines therapierefraktren, tdlichen Serotoninsyndroms entwickelte. Anschlieend werden die Pathophysiologie und mgliche Therapieoptionen dieses Krankheitsbildes dargestellt.The serotonin syndrome is caused by a drug-induced increase of the intrasynaptic serotonin concentration. Milder forms of the syndrome may be difficult to diagnose because of the variability of symptoms. Severe forms often rapidly turn into a life-threatening situation, therefore the serotonin syndrome may be a challenge for physicians. We describe the pathophysiology and therapeutic options of the serotonin syndrome and report about a 42-year-old female patient who ingested large amounts of moclobemide, a monoamine oxidase inhibitor, and citalopram, a selective serotonin reuptake inhibitor, for attempted suicide. Within a few hours the patient developed a lethal serotonin syndrome although ICU therapy was initiated immediately.
Der Anaesthesist 10/2006; 55(11):1189-1196. · 0.99 Impact Factor
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ABSTRACT: The purpose of this study is to evaluate the demographic characteristics of patients who suffered cardiac arrest in our ICUs and to identify those factors influencing outcome after resuscitation following cardiac arrest. We reviewed the records of all patients who underwent CPR in the two ICUs at the Georg-August University Hospital Goettingen, Germany from 1 January, 1999 to 31 December, 2003. During the study period 169 patients underwent CPR and 80 of the 169 patients survived to hospital discharge, giving a survival to hospital discharge rate of 47.3%. The initial monitored rhythm recorded at the time of arrest was asystole in 99 (58.6%) patients, ventricular tachycardia/fibrillation in 59 (34.9%) and pulseless electrical activity in 7 (4.1%) patients. The respective survival rates were 46 (54.8%), 31 (36.9%) and 5 (6.0%) to hospital discharge. Of the 80 patients that survived to hospital discharge 75 (93.8%) achieved good cerebral recovery (CPC 1 or 2) and were alert and fully oriented on discharge; 4 patients (5.0%) were severely disabled (CPC 3), while 1 (1.2%) remained unconscious and was reported dead five days after discharged to another local hospital. Illness severity as assessed by SAPS II score on admission was 38.8 +/- 16.0. None of our patients with > 40 SAPS II score 24 hours after CPR survived to be discharged from the ICU. Our study showed that nearly half the patients that had cardiac arrest in our hospital ICUs had a favourable outcome despite initial rhythms that are traditionally associated with a poor outcome. This confirms that good results are achievable in these groups of patients.
African Journal of Reproductive Health 05/2006; 10(1):104-15.
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ABSTRACT: We hypothesized, that in mechanically ventilated patients with acute respiratory failure, regional pressure volume curves differ markedly from conventional global pressure volume curves of the whole lung.
In nine mechanically ventilated patients with acute respiratory failure during an inspiratory low-flow manoeuvre, conventional global pressure volume curves were registered by spirometry and regional pressure volume curves in up to 912 regions were assessed simultaneously using electrical impedance tomography. We compared the lower (LIP) and upper (UIP) inflection points obtained from the conventional global pressure volume curve and regional pressure volume curves.
We identified from the conventional global pressure volume curves LIP [3-11 (8) cmH2O] in eight patients and UIP [31-39 (33) cmH2O] in three patients. Using electrical impedance tomography (EIT), LIP [3-18 (8) cmH2O] in 54-264 (180) regions and UIP [23-42 (36) cmH2O] in 149-324 (193) regions (range and median) were identified. Lung mechanics measured by conventional global pressure volume curves are similar to the median of regional pressure volume curves obtained by EIT within the tomographic plane. However, single regional pressure volume curves differ markedly with a broad heterogeneity of lower and upper inflection points.
Lower and upper inflection points obtained from conventional global pressure volume curves are not representative of all regions of the lungs.
Acta Anaesthesiologica Scandinavica 04/2006; 50(3):331-9. · 2.19 Impact Factor
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ABSTRACT: During mechanical ventilatory support, spontaneous breathing has been linked to improved hemodynamics. These findings may be explained by a decrease in intrathoracic pressure which may improve venous return to the heart. Such a mechanism should result in a dose-response relation between the amount of spontaneous breathing and an increase in the global end-diastolic volume (GEDV) and cardiac output (Q(t)).
To test this hypothesis, 15 patients were studied after major elective surgery during weaning from mechanical ventilation using bilevel positive airway pressure (BIPAP). BIPAP allows unrestricted spontaneous breathing during every phase of the respiratory cycle. Thus, ventilatory support was modified by changing the mechanical respiratory rate only, whereas inspiratory airway pressure and PEEP were kept constant. GEDV and Q(t) were measured by transpulmonary thermodilution.
GEDV (P = 0.055), stroke volume (P = 0.027) and subsequently also Q(t) (P < 0.001) increased when spontaneous breathing increased. In contrast, no difference was observed for central venous pressure (P = 0.19).
The beneficial hemodynamic effects of spontaneous breathing during mechanical ventilatory support can partially be explained by improved venous return to the heart which increases stroke volume and Q(t).
Acta Anaesthesiologica Scandinavica 12/2005; 49(10):1443-8. · 2.19 Impact Factor
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ABSTRACT: For the treatment of patients with adult respiratory distress syndrome and acute lung injury bedside measurements of regional lung ventilation should be considered for optimizing ventilatory settings. The aim was to investigate the effect of positive end-expiratory pressure (PEEP) on regional ventilation in mechanically ventilated patients at the bedside by electrical impedance tomography.
Eight mechanically ventilated patients were included in the study. PEEP levels were increased from 0 to 5, 10, 15 mbar and back to 0 mbar. Regional ventilation in 912 regions of the thorax was investigated at each PEEP by electrical impedance tomography. The obtained regions were divided in four groups: none (none and poorly ventilated regions including chest wall and mediastinum), bad, moderate and well-ventilated regions.
Increasing the PEEP stepwise from 0 to 15 mbar decreased the non-ventilated regions (none: 540 regions at PEEP 0 and 406 regions at PEEP 15). In contrast, the other regions increased (bad: 316 regions at PEEP 0 and 380 regions at PEEP 15; moderate: 40 regions at PEEP 0 and 100 regions at PEEP 15; well: 0 region at PEEP 0 and 34 regions at PEEP 15 (median values)) indicating an improvement of regional ventilation.
Increasing PEEP in mechanically ventilated patients reduces none ventilated regions (atelectasis). Furthermore, it leads to a shift from none and bad ventilated regions to moderately and well-ventilated regions. Electrical impedance tomography is a bedside technique and might be an alternative to computed tomography scan to assess aerated lung regions.
European Journal of Anaesthesiology 12/2005; 22(11):817-25. · 2.23 Impact Factor
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ABSTRACT: Non-depolarizing neuromuscular blocking agents have differential effects on the diaphragm and skeletal muscles. We employed a new method to study the effects of mivacurium on the diaphragm and compared the results obtained with this method with published data.
Anaesthesia was induced and maintained with propofol and alfentanil and the trachea was intubated after topical anaesthesia. Contractions of the diaphragm were induced by cervical magnetic stimulation of the phrenic nerves and quantified by measuring airway pressure responses. The neuromuscular effects on skeletal muscles were measured by acceleromyography of the adductor pollicis muscle. Mivacurium (0.15 mg kg(-1)) was injected and neuromuscular responses were recorded until the effects had waned.
Eleven male and 10 female patients (ASA I-II; 57 +/- 16 yr; 78 +/- 13 kg; mean +/- standard deviation) participated. Median maximal reduction of twitch response was less (P < 0.05) for the diaphragm (89%) than for the adductor pollicis (100%). Time to 25% recovery was shorter for the diaphragm than for the adductor pollicis (8.8 +/- 2.2 min vs. 22.6 +/- 5.0 min, P < 0.05). The difference between the recovery index of the diaphragm (7.3 min (3.6-18.4)) and the adductor pollicis (8.2 min (4.4-20.9) (median (range)) just missed our chosen level of statistical significance (P = 0.06). The recovery time to train-of-four 0.8 was shorter for the diaphragm (median and 95% confidence interval 25.1 +/- 10.2 min) than for the adductor pollicis (median and 95% confidence interval 37.5 +/- 9.4 min, P < 0.05).
The duration of the clinical effect of mivacurium on the diaphragm is markedly shorter than on the adductor pollicis muscles but there was only a small difference in the recovery index of the two muscles. These effects and the time courses determined with the new method closely resemble the results obtained with different methods in other studies.
European Journal of Anaesthesiology 07/2005; 22(7):530-5. · 2.23 Impact Factor
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ABSTRACT: It has been shown that racemic ketamine increases coronary blood flow and that this effect is at least in part due to a direct vasorelaxing effect of this substance. This study was designed to determine whether ketamine might stereoselectively relax isolated porcine coronary arteries.
Using the model of isolated vessels we studied the effects of S(+) ketamine, R(-) ketamine, and racemic ketamine (5-500 microg mL(-1)) on artery strips pre-contracted by either potassium chloride (KCl) or prostaglandin F2alpha (PGF2alpha). To elucidate possible mechanisms of action these experiments were repeated in the presence of one of the following compounds: N(omega)-nitro-L-arginine (L-NNA), indomethacin, glibenclamide, and tetraethylammonium (TEA) chloride, an inhibitor of the BK(Ca) K+ channel.
Both isoforms and racemic ketamine relaxed isolated coronary arteries in a concentration-dependent manner in concentrations beyond those used in clinical practice. S(+) ketamine exerted the strongest vasorelaxing effect, followed by racemic ketamine and R(-) ketamine. Pretreatment with L-NNA, indomethacin, or glibenclamide did not alter the vasodilating properties of ketamine, whereas TEA chloride significantly attenuated the vasorelaxing effects of all the three forms of ketamine.
Ketamine dilates coronary arteries in vitro when administered in high concentrations. There is a stereoselective difference with a stronger vasorelaxing effect of S(+) ketamine compared to racemic and R(-) ketamine. The impact of TEA chloride suggests that the activation of the BK(Ca) channel may contribute to the vasodilating effect of ketamine.
European Journal of Anaesthesiology 04/2005; 22(3):215-21. · 2.23 Impact Factor
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ABSTRACT: Hypotension, especially in elderly and hypovolaemic patients, is frequently associated with intravenous midazolam administration. The mechanisms are not completely understood. This study was designed to investigate the mechanisms involved in the relaxing effect of midazolam on coronary arteries.
The substance was studied in isolated porcine coronary artery rings precontracted by either potassium chloride or prostaglandin F2alpha.
Midazolam caused vasodilatation in a concentration-dependent manner. Relaxation was more pronounced in prostaglandin F2alpha precontracted segments than in those treated with potassium chloride (P < 0.001). Vasodilatation was unaffected by Nomega-nitro-L-arginine, indomethacin and glibenclamide. Tetraethylammonium chloride, an inhibitor of the BK(Ca) K+ channel (a high conductance Ca(2+)-sensitive K+ channel), dose dependently attenuated the vasodilating effect of midazolam (P < 0.01).
Hyperpolarization of the smooth muscle cell in the vessel wall, elicited by the activation the BK(Ca) K+ channel, may contribute to the vasorelaxing effect of midazolam.
European Journal of Anaesthesiology 03/2005; 22(2):135-9. · 2.23 Impact Factor
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European Journal of Anaesthesiology 02/2005; 22(03):215 - 221. · 2.23 Impact Factor
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ABSTRACT: Tracheotomy is commonly performed in long-term ventilated patients. The aim of this review is to discuss the advantages and disadvantages of tracheotomy.
Review of the literature.
Disadvantages of tracheotomy include the risk of bleeding, infection, injury of the truncus brachiocephalicus, and of long-term tracheal injury. These risks must be compared with the risk of vocal cord trauma, laryngeal trauma, and subglottic stenosis following translaryngeal intubation. Despite a number of disadvantages and potentially even life-threatening complications, however, tracheotomy is a well-established technique for long-term airway management in critically ill patients. Potential advantages of tracheotomy include enhanced patient comfort, reduced airway resistance and dead space, a lower incidence of ventilator-associated pneumonia and a shorter duration of mechanical ventilation and hospital stay. Patient comfort before and after tracheotomy has not yet been seriously evaluated, using modern ventilators airway resistance does not longer play a major role. No data from randomized controlled trials actually support the thesis that tracheotomy reduces the incidence of ventilator-associated pneumonia. There is weak evidence for the concept that the duration of mechanical ventilation can be reduced in patients while using tracheotomy. Patients undergoing percutaneous dilational tracheotomy seem to have a reduced risk of bleeding and site infection and a shorter duration of the procedure when compared to those with conventional surgical tracheotomy.
Many clinicians perform tracheotomies on the basis of expert opinion and clinical experience. So far, the benefits, however, have not been proven in large-scale randomized trials. Many of these studies suffer from design flaws, insufficient randomization and the absence of blinding. On the other hand, the lack of positive results do not rule out that tracheotomy may be beneficial for the ventilator-dependent patient. Percutaneous tracheotomy procedures may be superior to conventional surgical tracheotomies. Long-term results, however, will have to prove this preliminary observation.
ains · Anästhesiologie · Intensivmedizin 07/2004; 39(6):335-43. · 0.41 Impact Factor
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ABSTRACT: OBJECTIVE: Tracheotomy is commonly performed in long-term ventilated patients. The aim of this review is to discuss the advantages and disadvantages of tracheotomy. METHODS: Review of the literature. RESULTS: Disadvantages of tracheotomy include the risk of bleeding, infection, injury of the truncus brachiocephalicus, and of long-term tracheal injury. These risks must be compared with the risk of vocal cord trauma, laryngeal trauma, and subglottic stenosis following translaryngeal intubation. Despite a number of disadvantages and potentially even life-threatening complications, however, tracheotomy is a well-established technique for long-term airway management in critically ill patients. Potential advantages of tracheotomy include enhanced patient comfort, reduced airway resistance and dead space, a lower incidence of ventilator-associated pneumonia and a shorter duration of mechanical ventilation and hospital stay. Patient comfort before and after tracheotomy has not yet been seriously evaluated, using modern ventilators airway resistance does not longer play a major role. No data from randomized controlled trials actually support the thesis that tracheotomy reduces the incidence of ventilator-associated pneumonia. There is weak evidence for the concept that the duration of mechanical ventilation can be reduced in patients while using tracheotomy. Patients undergoing percutaneous dilational tracheotomy seem to have a reduced risk of bleeding and site infection and a shorter duration of the procedure when compared to those with conventional surgical tracheotomy. CONCLUSIONS: Many clinicians perform tracheotomies on the basis of expert opinion and clinical experience. So far, the benefits, however, have not been proven in large-scale randomized trials. Many of these studies suffer from design flaws, insufficient randomization and the absence of blinding. On the other hand, the lack of positive results do not rule out that tracheotomy may be beneficial for the ventilator-dependent patient. Percutaneous tracheotomy procedures may be superior to conventional surgical tracheotomies. Long-term results, however, will have to prove this preliminary observation
Anasthesiol.Intensivmed.Notfallmed.Schmerzther. 06/2004; 39.
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ABSTRACT: Metformin, an anti-hyperglycaemic drug, reduces mortality in obese patients with a non-insulin-dependent diabetes mellitus type II (United Kingdom Prospective Diabetes Study) and is therefore recommended as the first line therapy. A metformin-associated lactic acidosis due to accumulation or intoxication is a rare but severe complication with a mortality rate of up to 50%. The main clinical symptoms are unspecific and the patient may present with acute abdominal pain and reduced consciousness. This can easily be misinterpreted and may lead to a wrong diagnosis. Only a thorough clinical examination and exact analysis of laboratory values in combination with the medical history and chronic medication will allow a correct diagnosis. We report a case of a 79-year-old female patient whose clinical symptoms were initially interpreted as an acute intestinal ischemia. A progressively deteriorating haemodynamic state led to an exploratory laparotomy. Postoperatively, the correct diagnosis of a metformin-associated lactic acidosis due to acute renal failure was made. In the course of the ICU stay the condition improved after bicarbonate haemodialysis and the patient was discharged 11 days after admission.
Der Anaesthesist 03/2004; 53(2):153-6. · 0.99 Impact Factor
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ABSTRACT: Propofol may cause undesirable hypotension due to vasodilation. The underlying mechanisms are not completely understood. We investigated the mechanisms by which propofol relaxes vascular segments.
We studied the effect of propofol on isolated porcine coronary artery rings precontracted with potassium chloride or prostaglandin F2alpha.
Propofol, in a concentration-dependent manner, relaxed all segments at concentrations of 5 microg mL(-1) and above. This relaxation was unaltered in the presence of N(omega)-nitro-L-arginine, indomethacin, diltiazem and glibenclamide. Tetraethylammonium chloride, an inhibitor of the BK(Ca) K+ channel (a high conductance Ca2+-sensitive K+ channel), dose-dependently attenuated the vasodilating effect of propofol (P < 0.001).
Our results suggests that the activation of the BK(Ca) channel may contribute to the vasodilating effect of propofol, hereby causing hyperpolarization of the smooth muscle membrane and reduction of smooth muscle tone.
European Journal of Anaesthesiology 03/2004; 21(3):226-30. · 2.23 Impact Factor
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ABSTRACT: Metformin fhrt zu einer Reduktion der Letalitt bei bergewichtigen Typ-2-Diabetikern und ist damit auch nach den Richtlinien der Bundesrztekammer die Therapie der Wahl. Eine seltene aber schwerwiegende Komplikation der Therapie mit Biguaniden ist die Laktatacidose, die mit einer Mortalitt von bis zu 50% einhergeht. Die klinische Symptomatik ist uncharakteristisch. Im Vordergrund stehen gastrointestinale Beschwerden bis hin zum akuten Abdomen, die z.T. mit einer Bewusstseinstrbung einhergehen und leicht fehlinterpretiert werden knnen. Entscheidend sind die Anamnese unter Beachtung der Vormedikation, grndliche krperliche Untersuchung und aktuelle Laborparameter. Im Folgenden berichten wir ber den Fall einer 79-jhrigen Patientin mit Metforminintoxikation. Die klinische Symptomatik wurde zunchst als Darmischmie verkannt und bei zunehmender Kreislaufinstabilitt die Indikation zur explorativen Laparotomie gestellt. Erst postoperativ konnte die korrekte Diagnose einer Metformin-assoziierten Laktatacidose als Folge einer akuten Niereninsuffizienz gestellt werden. Unter kontinuierlicher Bikarbonathmodialyse besserte sich der Zustand im weiteren intensivstationren Verlauf. Am 11. postoperativen Tag konnte die Patientin aus dem Krankenhaus entlassen werden.Metformin, an antihyperglycaemic drug, reduces mortality in obese patients with a non-insulin-dependent diabetes mellitus type II (United Kingdom Prospective Diabetes Study) and is therefore recommended as the first line therapy. A metformin-associated lactic acidosis due to accumulation or intoxication is a rare but severe complication with a mortality rate of up to 50%. The main clinical symptoms are unspecific and the patient may present with acute abdominal pain and reduced consciousness. This can easily be misinterpreted and may lead to a wrong diagnosis. Only a thorough clinical examination and exact analysis of laboratory values in combination with the medical history and chronic medication will allow a correct diagnosis. We report a case of a 79-year-old female patient whose clinical symptoms were initially interpreted as an acute intestinal ischemia. A progressively deteriorating haemodynamic state led to an exploratory laparotomy. Postoperatively, the correct diagnosis of a metformin-associated lactic acidosis due to acute renal failure was made. In the course of the ICU stay the condition improved after bicarbonate haemodialysis and the patient was discharged 11days after admission.
Der Anaesthesist 01/2004; 53(2):153-156. · 0.99 Impact Factor
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ABSTRACT: The aim of the study was to investigate the effect of lung volume changes on end-expiratory lung impedance change (ELIC) in mechanically ventilated patients, since we hypothesized that ELIC may be a suitable parameter to monitor lung volume change at the bedside.
Clinical trial on patients requiring mechanical ventilation.
Intensive care units of a university hospital.
Ten mechanically ventilated patients were included in the study.
Patients were ventilated in volume-controlled mode with constant flow and respiratory rate. In order to induce changes in the end-expiratory lung volume (EELV), PEEP levels were increased from 0 mbar to 5 mbar, 10 mbar, and 15 mbar. At each PEEP level EELV was measured by an open-circuit nitrogen washout manoeuvre and ELIC was measured simultaneously using Electrical Impedance Tomography (EIT) with sixteen electrodes placed on the circumference of the thorax and connected with an EIT device. Cross-sectional electro-tomographic measurements of the thorax were performed at each PEEP level, and a modified Sheffield back-projection was used to reconstruct images of the lung impedance. ELIC was calculated as the average of the end-expiratory lung impedance change. RESULTS. Increasing PEEP stepwise from 0 mbar to 15 mbar resulted in an linear increase of EELV and ELIC according to the equation: y =0.98 x -0.68, r(2)=0.95.
EIT is a simple bedside technique which enables monitor lung volume changes during ventilatory manoeuvres such as PEEP changes.
Intensive Care Medicine 02/2003; 29(1):37-43. · 5.40 Impact Factor
