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Bellgardt M, Özcelik D, Breuer-Kaiser AFC, Steinfort C, Breuer TGK, Weber TP, Herzog-Niescery J. Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome. World J Crit Care Med 2021; 10:323-333. [PMID: 34888158 PMCID: PMC8613718 DOI: 10.5492/wjccm.v10.i6.323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/24/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS) is a severe complication of infection with severe acute respiratory syndrome coronavirus 2, and the primary cause of death in the current pandemic. Critically ill patients often undergo extracorporeal membrane oxygenation (ECMO) therapy as the last resort over an extended period. ECMO therapy requires sedation of the patient, which is usually achieved by intravenous administration of sedatives. The shortage of intravenous sedative drugs due to the ongoing pandemic, and attempts to improve treatment outcome for COVID-19 patients, drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy. Administration of volatile anesthetics requires an appropriate delivery. Commercially available ones are the anesthetic gas reflection systems AnaConDa® and MIRUSTM, and each should be combined with a gas scavenging system. In this review, we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS. We focus particularly on the technical details of administration of volatile anesthetics. Furthermore, we describe the advantages of inhaled sedation and volatile anesthetics, and we discuss the limitations as well as the requirements for safe application in the clinical setting.
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Affiliation(s)
- Martin Bellgardt
- Anesthesia and Intensive Care Medicine, St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, Bochum 44791, Germany
| | - Dennis Özcelik
- Chemistry | Biology | Pharmacy Information Center, ETH Zürich, Zürich 8093, Switzerland
| | | | - Claudia Steinfort
- General and Visceral Surgery, St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, Bochum 44791, Germany
| | - Thomas Georg Karl Breuer
- Internal Medicine/Intensive Care, St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, Bochum 44791, Germany
| | - Thomas Peter Weber
- Anesthesia and Intensive Care Medicine, St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, Bochum 44791, Germany
| | - Jennifer Herzog-Niescery
- Anesthesia and Intensive Care Medicine, St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, Bochum 44791, Germany
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Breuer TGK, Kampmann K, Wutzler A, Steinfort C, Uhl W, Schmidt WE, Meier JJ. [Severe atypical ketoacidosis due to SGLT2-inhibitor therapy : Two case reports]. Internist (Berl) 2019; 59:282-287. [PMID: 28864828 DOI: 10.1007/s00108-017-0316-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two female patients were admitted due to ketoacidosis. Serum glucose was moderately elevated. The patients exhibited abdominal and neurologic symptoms. Treatment consisted of metformin, insulin glargin and empagliflozin, as well as glimepiride, insulin detemir and empagliflozin, respectively. Treatment with intravenous fluid replacement, insulin, glucose, potassium and buffer solution led to a normalisation of pH and serum glucose levels. Our report describes two cases of atypical ketoacidosis with moderately elevated serum glucose during sodium-glucose co-transporter-2 (SGLT2) inhibitor therapy.
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Affiliation(s)
- T G K Breuer
- Diabetes-Zentrum Bochum/Hattingen, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - K Kampmann
- Diabetes-Zentrum Bochum/Hattingen, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - A Wutzler
- Abteilung für Elektrophysiologie, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Deutschland
| | - C Steinfort
- Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Deutschland
| | - W Uhl
- Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Deutschland
| | - W E Schmidt
- Diabetes-Zentrum Bochum/Hattingen, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - J J Meier
- Diabetes-Zentrum Bochum/Hattingen, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
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Abstract
BACKGROUND The incidence of sarcoidosis in Australia is unknown. The clinical features, diagnostic strategy and treatment of sarcoidosis in Australia have been poorly documented. METHODS We analysed the medical records of 122 patients with sarcoidosis presenting to a respiratory service, between 1995 and 2005, which serves a regional southeastern Australian population of approximately 200,000. RESULTS The incidence of sarcoidosis from 2000 to 2005 remained static and ranged from 4.4 to 6.3 patients per 100,000 population. The data showed that 55% were women and 28% were current smokers. Systems involved included lung parenchyma (66%), thoracic adenopathy (58%), skin (22%), ocular (18%), joint (11%), gastrointestinal tract (5%), central nervous system (3%) and hypercalcaemia (3%). Fifty-one per cent of patients had an increased serum angiotensin-converting enzyme level. The diagnosis was secured based on histological confirmation in 69%. Forty-three per cent of the patients were treated with oral corticosteroids and 10% with inhaled steroids. CONCLUSION Sarcoidosis in Australia is a multi-system disease of unknown aetiology. This is the first reported incidence of sarcoidosis in Australia. The incidence is similar to another US-based epidemiological study of a predominately white population. The development of a larger multicentre database would assist in the identification, clinical description and treatment of sarcoidosis.
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Affiliation(s)
- A Gillman
- Department of Respiratory medicine, Geelong Hospital, Geelong, Victoria, Australia.
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Abstract
Recurrent Gram-negative bacterial infection is a significant cause of death in patients with bronchiectasis and severe chronic obstructive pulmonary disease (COPD). Nebulized colistin in cystic fibrosis has shown maintenance of pulmonary function and improved symptom scores. We prospectively followed 18 patients with chronic bronchial sepsis treated with nebulized colistin 30 mg daily. Mean decline in forced expiratory volume in 1 s was significantly slower following commencement of inhaled colistin (44 mL/year vs 104 mL/year, P = 0.035). Mean decline in forced vital capacity was also significantly slower following commencement of colistin (48 mL/year vs 110 mL/year, P = 0.033). Patient-reported quality of life improved following commencement of colistin (3.6 vs 6.2, P = 0.001). No patient had isolates resistant to colistin. No side-effects were reported by patients in the cohort. Use of inhaled colistin in the treatment of bronchiectasis and severe (COPD) in patients with recurrent Gram-negative infections is safe. Inhaled colistin may improve quality of life and slow decline in forced expiratory volume in 1 s and forced vital capacity.
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Affiliation(s)
- D P Steinfort
- Respiratory Department, Geelong Hospital, Melbourne, Victoria, Australia.
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Weyhe D, Geier B, Belyaev O, Steinfort C, Uhl W, Zumtobel V. Central perineal hernia mimicking rectocele: a case report. Langenbecks Arch Surg 2005; 391:43-6. [PMID: 16261390 DOI: 10.1007/s00423-005-0007-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 09/21/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND A perineal hernia is a very rare clinical finding. Three forms are distinguished: anterior, posterior, and central. Diagnosis of the last one is difficult, and sometimes, it is falsely named a posterior rectocele. AIM This work presents a successfully treated case of central perineal hernia and makes a brief summary of existent literature on the problem. PRESENTATION OF THE CASE We report of a 67-year-old female patient with a symptomatic central pelvic floor hernia. After radiological confirmation of the diagnosis, a transperitoneal approach was chosen to reposition the protruded segment of the small bowel. The hernial orifice was closed by extraperitoneal implantation of a polypropylene mesh. DISCUSSION In the present case, the use of a laparoscopic technique seemed unsuitable due to the extension of the findings. For the repair of perineal hernia, we followed the principles of the "tension-free" concept. If there are no signs of a pelvic floor infection and if the mesh can be implanted totally extraperitoneally, we recommend the use of nonabsorbable alloplastic material (polypropylene) for reinforcement of the pelvic floor as a suitable technique for the repair of large perineal hernias.
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Affiliation(s)
- Dirk Weyhe
- Department of Surgery, St. Josef Hospital-University Medical Center, Ruhr University Bochum, Bochum, Germany.
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Senkal M, Haaker R, Deska T, Hummel T, Steinfort C, Zumtobel V, Alteheld B, Stehle P. Early enteral gut feeding with conditionally indispensable pharmaconutrients is metabolically safe and is well tolerated in postoperative cancer patients--a pilot study. Clin Nutr 2005; 23:1193-8. [PMID: 15380913 DOI: 10.1016/j.clnu.2004.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2003] [Accepted: 03/31/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND & AIMS Postoperative early enteral gut feeding with conditionally indispensable pharmaconutrients can contribute to minimize trauma-induced gut damage. Aim of this pilot study was the evaluation of metabolic effects and gastrointestinal tolerance of a new enteral supplement. METHODS In a prospective open clinical trial, 20 cancer patients received the test supplement containing glutamine (as dipeptides), antioxidative (pro-)vitamins (C, E, beta-carotene), maltodextrine, tributyrine, sodium, zinc, and selenium within 2-3 h after elective gastrointestinal surgery continuously via jejunostomy tube for 3 postoperative days (500 ml/day). From postoperative day 3-5, additional enteral nutrition (1500 kcal/6270 kJ/day) was given. Metabolic effects (substrate monitoring, hematology, liver/kidney parameters) and tolerance (nausea, vomiting, flatulence, constipation, diarrhea) was assessed through the study. RESULTS Gastrointestinal tolerance of the supplement was excellent: no adverse events related to the product were documented. Significantly increased mean plasma levels (day 3 vs. day 1) of vitamin C (13.0 +/- 7.3 vs. 62.8 +/- 29.7 micromol/l), vitamin E (13.5 +/- 6.6 vs. 20.8 +/- 9.2 micromol/l), zinc (5.6 +/- 1.9 vs. 8.6 +/- 2.3 micromol/l) and selenium (35.0 +/- 19.6 vs. 42.9 +/- 0.9 microg/l) as well as enhanced plasma glutamine levels (429.6 +/- 90.6 vs. 530 +/- 200.1 micromol/l) reflected an effective absorption of substrates supplied. Adverse effects on organ functions and hematology were not observed. CONCLUSIONS Early postoperative gut feeding with the newly developed enteral supplement shows no adverse effects, is well tolerated in cancer patients and provides a novel method to deliver conditionally indispensable pharmaconutrients.
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Affiliation(s)
- Metin Senkal
- Department of Surgery, Ruhr-University Bochum, St. Josef Hospital, Germany.
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Steinfort C, Wilson R, Mitchell T, Feldman C, Rutman A, Todd H, Sykes D, Walker J, Saunders K, Andrew PW. Effect of Streptococcus pneumoniae on human respiratory epithelium in vitro. Infect Immun 1989; 57:2006-13. [PMID: 2731981 PMCID: PMC313834 DOI: 10.1128/iai.57.7.2006-2013.1989] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
A total of 11 of 15 Streptococcus pneumoniae culture filtrates and all five bacterial autolysates produced by cell death in the stationary phase caused slowed ciliary beating and disruption of the surface integrity of human respiratory epithelium in organ culture. This effect was inhibited by cholesterol and was heat labile and reduced by standing at room temperature but was stable at -40 degrees C. The activity was detected at the late stationary phase of culture and was associated with the presence of hemolytic activity. Gel filtration of a concentrated culture filtrate and autolysate both yielded a single fraction of approximately 50 kilodaltons which slowed ciliary beating and were the only fractions with hemolytic activity. Rabbit antiserum to pneumolysin, a sulfhydryl-activated hemolytic cytotoxin released by S. pneumoniae during autolysis, neutralized the effect of the culture filtrate on respiratory epithelium. Both native and recombinant pneumolysin caused ciliary slowing and epithelial disruption. Electron microscopy showed a toxic effect of pneumolysin on epithelial cells: cytoplasmic blebs, mitochondrial swelling, cellular extrusion, and cell death, but no change in ciliary ultrastructure. Recombinant pneumolysin (10 micrograms/ml) caused ciliary slowing in the absence of changes in cell ultrastructure. Release of pneumolysin in the respiratory tract during infection may perturb host defenses, allowing bacterial proliferation and spread.
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Affiliation(s)
- C Steinfort
- Department of Thoracic Medicine, Brompton Hospital, London, United Kingdom
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Steinfort C, Wilson R, Rutman A, Sykes D, Todd H, Walker J, Mitchell T, Saunders K, Andrew P, Boulnois G, Cole P. Pneumolysin Produced by Streptococcus pneumoniae Damages Human Respiratory Epithelium in vitro. Chest 1989. [DOI: 10.1378/chest.95.3_supplement.221s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Sykes DA, Wilson R, Greenstone M, Currie DC, Steinfort C, Cole PJ. Deleterious effects of purulent sputum sol on human ciliary function in vitro: at least two factors identified. Thorax 1987; 42:256-61. [PMID: 3303429 PMCID: PMC460695 DOI: 10.1136/thx.42.4.256] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Patients with chronic bronchial sepsis have impaired mucociliary clearance. A study was carried out on the effect of sputum sol (obtained by rapid centrifugation of purulent sputum) from 20 patients with chronic bronchial sepsis on the beating of human nasal cilia in vitro by a photometric technique. Thirteen sols caused significant (p less than 0.001) ciliary slowing. Two patterns of slowing were observed: firstly, a gradual onset associated with epithelial disruption (inhibited by alpha 1 antiprotease) and, secondly, an immediate onset associated with ciliary dyskinesia and ciliostasis (inhibited by chloroform extraction). The ciliary slowing activity of sputum sols was associated with the isolation of Pseudomonas aeruginosa (p less than 0.01). It is concluded that purulent sputum contains at least two factors that impair ciliary beating--one a serine protease, which is probably a product released by the host's phagocytic defences, and the other, which is chloroform extractable and probably a bacterial product.
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