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Klafke N, Bossert J, Kröger B, Neuberger P, Heyder U, Layer M, Winkler M, Idler C, Kaschdailewitsch E, Heine R, John H, Zielke T, Schmeling B, Joy S, Mertens I, Babadag-Savas B, Kohler S, Mahler C, Witt CM, Steinmann D, Voiss P, Stolz R. Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy (CIPN) with Non-Pharmacological Interventions: Clinical Recommendations from a Systematic Scoping Review and an Expert Consensus Process. Med Sci (Basel) 2023; 11:medsci11010015. [PMID: 36810482 PMCID: PMC9944490 DOI: 10.3390/medsci11010015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 01/31/2023] Open
Abstract
Background: Most individuals affected by cancer who are treated with certain chemotherapies suffer of CIPN. Therefore, there is a high patient and provider interest in complementary non-pharmacological therapies, but its evidence base has not yet been clearly pointed out in the context of CIPN. Methods: The results of a scoping review overviewing the published clinical evidence on the application of complementary therapies for improving the complex CIPN symptomatology are synthesized with the recommendations of an expert consensus process aiming to draw attention to supportive strategies for CIPN. The scoping review, registered at PROSPERO 2020 (CRD 42020165851), followed the PRISMA-ScR and JBI guidelines. Relevant studies published in Pubmed/MEDLINE, PsycINFO, PEDro, Cochrane CENTRAL, and CINAHL between 2000 and 2021 were included. CASP was used to evaluate the methodologic quality of the studies. Results: Seventy-five studies with mixed study quality met the inclusion criteria. Manipulative therapies (including massage, reflexology, therapeutic touch), rhythmical embrocations, movement and mind-body therapies, acupuncture/acupressure, and TENS/Scrambler therapy were the most frequently analyzed in research and may be effective treatment options for CIPN. The expert panel approved 17 supportive interventions, most of them were phytotherapeutic interventions including external applications and cryotherapy, hydrotherapy, and tactile stimulation. More than two-thirds of the consented interventions were rated with moderate to high perceived clinical effectiveness in therapeutic use. Conclusions: The evidence of both the review and the expert panel supports a variety of complementary procedures regarding the supportive treatment of CIPN; however, the application on patients should be individually weighed in each case. Based on this meta-synthesis, interprofessional healthcare teams may open up a dialogue with patients interested in non-pharmacological treatment options to tailor complementary counselling and treatments to their needs.
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Affiliation(s)
- Nadja Klafke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Correspondence:
| | - Jasmin Bossert
- Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Birgit Kröger
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Petra Neuberger
- National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Ute Heyder
- Women’s Clinic, Community Hospital Karlsruhe, 76133 Karlsruhe, Germany
| | - Monika Layer
- Center for Integrative Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Marcela Winkler
- Department of Naturopathy and Integrative Medicine, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
| | - Christel Idler
- Department of Naturopathy and Integrative Medicine, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
| | - Elke Kaschdailewitsch
- Center for Integrative Oncology, Die Filderklinik, 70794 Filderstadt-Bonlanden, Germany
| | - Rolf Heine
- Anthroposophic Nursing Network in Germany, Academy for Nursing Professions at the Filderklinik, Die Filderklinik, 70794 Filderstadt-Bonlanden, Germany
| | - Heike John
- Clinic for Radiation Therapy and Special Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Tatjana Zielke
- Clinic for Radiation Therapy and Special Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Beeke Schmeling
- Clinic for Radiation Therapy and Special Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Sosamma Joy
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45136 Essen, Germany
| | - Isabel Mertens
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45136 Essen, Germany
| | - Burcu Babadag-Savas
- Clinic for Radiation Therapy and Special Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Sara Kohler
- Department of Health, Zurich University of Applied Sciences, 8401 Winterthur, Switzerland
| | - Cornelia Mahler
- Department of Nursing Science, Institute of Health Sciences, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Claudia M. Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zürich and University of Zürich, 8091 Zürich, Switzerland
| | - Diana Steinmann
- Clinic for Radiation Therapy and Special Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Petra Voiss
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45136 Essen, Germany
| | - Regina Stolz
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, 72076 Tübingen, Germany
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Stolz R, Klafke N, Kröger B, Boltenhagen U, Kaltenbach A, Heine R, Idler C, Layer M, Kohler S, Winkler M, Voiss P, Joos S, Mahler C. [Creating evidence for naturopathic nursing interventions in oncology - a systematic approach]. Z Evid Fortbild Qual Gesundhwes 2021; 166:1-7. [PMID: 34563466 DOI: 10.1016/j.zefq.2021.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Nurses working in oncology use a wide range of naturopathic interventions in their daily practice to alleviate symptoms and improve the quality of life of oncological patients. However, there is no external evidence for many of these interventions. Due to a lack of scientific studies in the field, the aim of the project described here is to develop a standardized procedure to generate evidence on naturopathic interventions, on the basis of which recommendations may be derived for nursing practice. METHOD The systematic procedure presented here was developed by the working group (WG) Integrative Nursing in Oncology over a period of four years in an iterative process. This process is based on the expert panel members' experience with the development of guidelines and/or quality instruments such as practice standards. RESULT The systematic methodological approach presented here consists of three successive steps where internal and external evidence have been combined: a scoping review, a structured consensus process with oncology nurses to collect and evaluate naturopathic interventions, and finally a further supplementary literature review based on additional findings of the consensus conference. The procedure was successfully carried out for mucositis, insomnia, fatigue, hand-foot syndrome and chemotherapy-induced polyneuropathy. CONCLUSION Through the step-by-step synthesis of internal evidence and the best available external evidence, the evidence base for naturopathic nursing interventions in oncology can be generated and practice recommendations derived. The procedure represents a successful theory-practice transfer through structured cooperation between (nursing) scientists and nursing practitioners. In terms of the AWMF classification, the practice recommendations developed in the process described fall somewhere in between an S1 guideline (informal consensus of an expert group) and an S2e guideline (evidence-based).
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Affiliation(s)
- Regina Stolz
- Universitätsklinikum Tübingen. Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Tübingen, Deutschland.
| | - Nadja Klafke
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Heidelberg, Deutschland
| | - Birgit Kröger
- Universitätsklinikum Tübingen. Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Tübingen, Deutschland
| | - Ursula Boltenhagen
- Universitätsklinikum Tübingen. Institut für Gesundheitswissenschaften, Abteilung Pflegewissenschaft, Tübingen, Deutschland
| | - Anna Kaltenbach
- Universitätsklinikum Tübingen. Institut für Gesundheitswissenschaften, Abteilung Pflegewissenschaft, Tübingen, Deutschland
| | - Rolf Heine
- Netzwerk Anthroposophische Pflege in Deutschland, Akademie für Pflegeberufe an der Filderklinik, Filderstadt, Deutschland
| | - Christel Idler
- Robert-Bosch-Krankenhaus, Naturheilkunde und Integrative Medizin, Stuttgart, Deutschland
| | - Monika Layer
- Kantonsspital St. Gallen, Zentrum für Integrative Medizin, St. Gallen, Schweiz
| | - Sara Kohler
- Zürcher Hochschule für Angewandte Wissenschaften, Departement Gesundheit, Winterthur, Schweiz
| | - Marcela Winkler
- Robert-Bosch-Krankenhaus, Naturheilkunde und Integrative Medizin, Stuttgart, Deutschland
| | - Petra Voiss
- Evang. Kliniken Essen-Mitte, Klinik für Senologie/Brustzentrum, Integrative Onkologie/Naturheilkunde, Essen, Deutschland
| | - Stefanie Joos
- Universitätsklinikum Tübingen. Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Tübingen, Deutschland
| | - Cornelia Mahler
- Universitätsklinikum Tübingen. Institut für Gesundheitswissenschaften, Abteilung Pflegewissenschaft, Tübingen, Deutschland
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Steinmann D, Babadağ Savaş B, Felber S, Joy S, Mertens I, Cramer H, Paul A, Layer M, Klafke N, Stolz R, Heyder U, Neuberger P, Winkler M, Idler C, Heine R, Kaschdailewitsch E, John H, Schmeling B, Zielke T, Horneber M, Witt CM, Voiss P. Nursing Procedures for the Prevention and Treatment of Mucositis Induced by Cancer Therapies: Clinical Practice Guideline Based on an Interdisciplinary Consensus Process and a Systematic Literature Search. Integr Cancer Ther 2021; 20:1534735420940412. [PMID: 33467951 PMCID: PMC7960907 DOI: 10.1177/1534735420940412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Patients with cancer receiving tumor therapy often suffer from oral mucositis. Objectives: The aim of this project was to summarize experiences with nursing procedures by experts in integrative oncology and to establish recommendations for nursing interventions that can prevent or cure mucositis. Methods: The study design was an interdisciplinary consensus process based on a systematic literature search. Results: The panel discussed and agreed on 19 nursing procedures, which included mouthwashes, such as teas, supplements, oil applications, and different kinds of ice cubes to suck, as well as flaxseed solution, propolis, and mare milk. Twelve interventions were classified as effective, with effectiveness for OraLife, propolis, sea buckthorn pulp oil, marshmallow root tea also for xerostomia, Helago chamomile oil, mare milk, and Saliva Natura rated as highly effective in clinical experience. In the systematic literature search, a total of 12 out of 329 randomized controlled trials and meta-analyses on chamomile (n = 3), Calendula (n = 1) and sage (n = 1), propolis (n = 2), and sucking ice cubes (cryotherapy; n = 5) met all inclusion criteria. Trial evidence for effectiveness in oral mucositis was revealed for propolis and cryotherapy. Conclusions: The current evidence supports the use of some nursing procedures (f.e. propolis for 2 and 3 grade mucositis) for improving oral mucositis during cancer therapies. There is still a need to define general clinical practice guidelines for the supportive treatment of mucositis, as well as for more interdisciplinary research in this area.
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Affiliation(s)
| | | | - Sabine Felber
- Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
| | - Sosamma Joy
- Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
| | - Isabelle Mertens
- Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
| | - Holger Cramer
- Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
| | - Anna Paul
- Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
| | - Monika Layer
- Kantonsspital St. Gallen, Centre for Integrative Medicine, Sankt Gallen, Switzerland
| | - Nadja Klafke
- University Hospital Heidelberg, Heidelberg, Germany
| | - Regina Stolz
- University Hospital Tuebingen, Baden-Württemberg, Germany.,Tropenklinik Paul-Lechler-Krankenhaus, Tuebingen, Germany
| | - Ute Heyder
- Community Hospital Karlsruhe, Karlsruhe, Baden-Württemberg, Germany
| | | | - Marcela Winkler
- Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Baden-Württemberg, Germany
| | - Christel Idler
- Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Baden-Württemberg, Germany
| | - Rolf Heine
- Akademie für Pflegeberufe an der Filderklinik, Filderstadt, Germany
| | | | - Heike John
- Medizinische Hochschule Hannover, Hannover, Germany
| | | | | | | | - Claudia M Witt
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Petra Voiss
- Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
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Layer M, Bock K, Ranzinger F, Horn H, Morgenroth E, Derlon N. Particulate substrate retention in plug-flow and fully-mixed conditions during operation of aerobic granular sludge systems. Water Res X 2020; 9:100075. [PMID: 33196033 PMCID: PMC7645637 DOI: 10.1016/j.wroa.2020.100075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
Particulate substrate (XB) is the major organic substrate fraction in most municipal wastewaters. However, the impact of XB on aerobic granular sludge (AGS) systems is not fully understood. This study evaluated the physical retention of XB in AGS sequencing batch reactor (SBR) during anaerobic plug-flow and then aerobic fully-mixed conditions. The influence of different sludge types and operational variables on the extent and mechanisms of XB retention in AGS SBR were evaluated. XB mass-balancing and magnetic resonance imaging (MRI) were applied. During the anaerobic plug-flow feeding, most XB was retained in the first few cm of the settled sludge bed within the interstitial voids, where XB settled and accumulated ultimately resulting in the formation of a filter-cake. Sedimentation and surface filtration were thus the dominant XB retention mechanisms during plug-flow conditions, indicating that contact and attachment of XB to the biomass was limited. XB retention was variable and influenced by the XB influent concentration, sludge bed composition and upflow feeding velocity (vww). XB retention increased with larger XB influent concentrations and lower vww, which demonstrated the importance of sedimentation on XB retention during plug-flow conditions. Hence, large fractions of influent XB likely re-suspended during aerobic fully-mixed conditions, where XB then preferentially and rapidly attached to the flocs. During fully-mixed conditions, increasing floc fractions, longer mixing times and larger XB concentrations increased XB retention. Elevated XB retention was observed after short mixing times < 60 min when flocs were present, and the contribution of flocs towards XB retention was even more pronounced for short mixing times < 5 min. Overall, our results suggest that flocs occupy an environmental niche that results from the availability of XB during aerobic fully-mixed conditions of AGS SBR. Therefore, a complete wash-out of flocs is not desirable in AGS systems treating municipal wastewater.
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Affiliation(s)
- M. Layer
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, 8600, Dübendorf, Switzerland
- ETH Zürich, Institute of Environmental Engineering, 8093, Zürich, Switzerland
| | - K. Bock
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, 8600, Dübendorf, Switzerland
| | - F. Ranzinger
- Engler-Bunte-Institut, Karlsruhe Institute of Technology, 76131, Karlsruhe, Germany
| | - H. Horn
- Engler-Bunte-Institut, Karlsruhe Institute of Technology, 76131, Karlsruhe, Germany
| | - E. Morgenroth
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, 8600, Dübendorf, Switzerland
- ETH Zürich, Institute of Environmental Engineering, 8093, Zürich, Switzerland
| | - N. Derlon
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, 8600, Dübendorf, Switzerland
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Layer M, Adler A, Reynaert E, Hernandez A, Pagni M, Morgenroth E, Holliger C, Derlon N. Organic substrate diffusibility governs microbial community composition, nutrient removal performance and kinetics of granulation of aerobic granular sludge. Water Res X 2019; 4:100033. [PMID: 31334496 PMCID: PMC6614711 DOI: 10.1016/j.wroa.2019.100033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 05/25/2023]
Abstract
Basic understanding of formation of aerobic granular sludge (AGS) has mainly been derived from lab-scale systems with simple influents containing only highly diffusible volatile fatty acids (VFA) as organic substrate. This study compares start-up of AGS systems fed by different synthetic and municipal wastewaters (WW), characterised by increasing complexity in terms of non-diffusible organic substrate. Four AGS reactors were started with the same inoculum activated sludge and operated for one year. The development of AGS, settling characteristics, nutrient and substrate removal performance as well as microbial community composition were monitored. Our results indicate that the higher the content of diffusible organic substrate in the WW, the faster the formation of AGS. The presence of non-diffusible organic substrate in the influent WW led to the formation of small granules and to the presence of 20-40% (% of total suspended solids) of flocs in the AGS. When AGS was fed with complex influent WW, the classical phosphorus and glycogen accumulating organisms (PAO, GAO) were outcompeted by their fermentative equivalents. Substrate and nutrient removal was observed in all reactors, despite the difference in physical and settling properties of the AGS, but the levels of P and N removal depended on the influent carbon composition. Mechanistically, our results indicate that increased levels of non-diffusible organic substrate in the influent lower the potential for microbial growth deep inside the granules. Additionally, non-diffusible organic substrates give a competitive advantage to the main opponents of AGS formation - ordinary heterotrophic organisms (OHO). Both of these mechanisms are suspected to limit AGS formation. The presented study has relevant implications for both practice and research. Start-up duration of AGS systems treating high complexity WW were one order of magnitude higher than a typical lab-scale system treating VFA-rich synthetic WW, and biomass as flocs persisted as a significant fraction. Finally, the complex synthetic influent WW - composed of VFA, soluble fermentable and particulate substrate - tested here seems to be a more adequate surrogate of real municipal WW for laboratory studies than 100%-VFA WW.
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Affiliation(s)
- M. Layer
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600, Dübendorf, Switzerland
- ETH Zürich, Institute of Environmental Engineering, 8093, Zürich, Switzerland
| | - A. Adler
- Ecole Polytechnique Fédérale de Lausanne (EPFL), ENAC IIE Laboratory for Environmental Biotechnology, 1015, Lausanne, Switzerland
| | - E. Reynaert
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600, Dübendorf, Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL), ENAC IIE Laboratory for Environmental Biotechnology, 1015, Lausanne, Switzerland
| | - A. Hernandez
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600, Dübendorf, Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL), ENAC IIE Laboratory for Environmental Biotechnology, 1015, Lausanne, Switzerland
| | - M. Pagni
- SIB Swiss Institute of Bioinformatics, 1015, Lausanne, Switzerland
| | - E. Morgenroth
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600, Dübendorf, Switzerland
- ETH Zürich, Institute of Environmental Engineering, 8093, Zürich, Switzerland
| | - C. Holliger
- Ecole Polytechnique Fédérale de Lausanne (EPFL), ENAC IIE Laboratory for Environmental Biotechnology, 1015, Lausanne, Switzerland
| | - N. Derlon
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600, Dübendorf, Switzerland
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6
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Affiliation(s)
- K Wiedemann
- Abteilung für Anästhesiologie und Intensivmedizin, Thoraxklinik am Universitätsklinikum Heidelberg.
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Wiedemann K, Männle C, Layer M, Herth F. Anesthesia in Thoracic Surgery - CME Questionnaire. Anasthesiol Intensivmed Notfallmed Schmerzther 2004. [DOI: 10.1055/s-2004-826072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wiedemann K, Männle C, Layer M, Herth F. Anesthesia in Thoracic Surgery - CME Reply Form. Anasthesiol Intensivmed Notfallmed Schmerzther 2004. [DOI: 10.1055/s-2004-826071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sentürk M, Layer M, Pembeci K, Toker A, Akpir K, Wiedemann K. Oxygenierung während Ein-Lungen-Ventilation: Ein Vergleich von FiO2 0,5 und CPAP auf der nichtventilierten Lunge vs. FiO2 1,0. Anasthesiol Intensivmed Notfallmed Schmerzther 2004; 39:360-4. [PMID: 15197670 DOI: 10.1055/s-2004-814506] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 10/26/2022]
Abstract
OBJECTIVE In a prospective, randomised, double-blind study the effects of FiO (2) of 0,5 with CPAP and a FiO (2) of 1.0 without CPAP on oxygenation and pulmonary shunt during one-lung ventilation (OLV) were examined. METHODS In 20 patients undergoing thoracotomy (ASA II/III) two sequential ventilation methods were used during OLV: a) FiO (2) of 1.0 (OLV-100) and b) a FiO (2) of 0.5 in N (2)O combined with CPAP of 5 cm H (2)O to the non-ventilated lung (OLV-CPAP), whereby the sequence in 10 patients was OLV-CPAP followed by OLV-100; and the opposite in the remaining 10 patients. Operating conditions were graded by the surgeon. RESULTS OLV-CPAP was associated with a better oxygenation and a lower shunt compared to OLV-100 (paO (2) : 198 +/- 40 mmHg vs 181 +/- 38 mmHg; p < 0.05 and Qs/Qt: 30 +/- 6 % vs. 34 +/- 8 %; p < 0.01, respectively). The different sequence of the ventilation methods did not cause significant differences in the results. The surgical conditions were not impaired by the CPAP of 5 cm H (2)O. CONCLUSION The application of low FiO (2) with CPAP provided a better oxygenation and a lower pulmonary shunt during the OLV compared to high FiO (2) without CPAP.
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Affiliation(s)
- M Sentürk
- Abteilung für Anästhesiologie, Istanbul Universität, Medizinische Fakultät, Istanbul.
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Biro P, Layer M, Becker HD, Herth F, Wiedemann K, Seifert B, Spahn DR. Influence of airway-occluding instruments on airway pressure during jet ventilation for rigid bronchoscopy. Br J Anaesth 2000; 85:462-5. [PMID: 11103191 DOI: 10.1093/bja/85.3.462] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 11/13/2022] Open
Abstract
We measured changes in airway pressure (Paw) caused by microsurgical instruments introduced into a rigid bronchoscope during high frequency jet ventilation (HFJV). With approval of the institutional Ethics Committee, 10 adults undergoing elective tracheobronchial endoscopy and endosonography during general anaesthesia were investigated. Inflation of an endosonography probe balloon in the left main stem bronchus caused airway obstruction. Pressure measurements proximal and distal to the obstruction were compared after three degrees of obstruction (0%, 50% and 90%) and with two different driving pressure settings. Airway obstruction increased the mean (SD) peak inspiratory pressure (PIP) from 7.5 (2.6) to 9.5 (3.5) mm Hg for 2 atm (P = 0.0008) and from 9.7 (3.7) to 13.0 (5.1) mm Hg for 3 atm (P = 0.0001). Airway obstruction did not alter peripheral PIP (7.2 (4.1) to 7.1 (3.7) mm Hg for 2 atm and 8.8 (4.3) to 9.4 (5.2) mm for 3 atm), but resulted in an end-expiratory pressure (EEP) beyond the narrowing being significantly greater than in the unobstructed airway (2.5 (3.4) to 5.5 (3.7) mm Hg for 2 atm; P = 0.0005) and 3.2 (3.6) to 8.0 (4.3) mm for 3 atm; P < 0.0001). Severe airway narrowing increases inspiratory pressure proximal and expiratory pressure distal to the obstruction in relation to the applied driving pressure. Since the distal EEP never exceeded PIP, even near-total airway obstruction should not cause severe lung distension or barotrauma in subjects with normal lungs.
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Affiliation(s)
- P Biro
- Institute of Anaesthesiology, University Hospital Zurich, Switzerland
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Abstract
Oxygen saturation and carbon dioxide values should be monitored during high-frequency jet ventilation (HFJV). Modern transcutaneous PCO2 (PtcCO2) measurement allows the estimation of ventilation efficiency. We studied how tests of lung function could predict carbon dioxide elimination during HFJV. Lung function tests from 180 adult patients undergoing rigid bronchoscopy were analysed as factors affecting carbon dioxide elimination. The lung function test results showed a significant relationship with the efficiency of carbon dioxide elimination; the greatest impairment of carbon dioxide elimination was found in patients with combined abnormalities of lung function. Further factors associated with difficult carbon dioxide elimination were male gender and elevated body weight. Of the patients investigated, 72% had normal carbon dioxide elimination, whereas in 23% hypercapnia could be avoided only by increasing the driving pressure. The prevalence of abnormal preoperative lung function test results predicts (sensitivity 76%, positive predictive value 27%) impaired carbon dioxide elimination during jet ventilation and rigid bronchoscopy.
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Affiliation(s)
- P Biro
- Institute of Anaesthesiology, University Hospital Zurich, Switzerland
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Männle C, Layer M, Vogt-Moykopf I, Becker HD, Zilow EP, Wiedemann K. [High frequency jet ventilation during tracheal resection in children and infants]. Anasthesiol Intensivmed Notfallmed Schmerzther 1997; 32:21-6. [PMID: 9138540 DOI: 10.1055/s-2007-995002] [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] [Indexed: 02/04/2023]
Abstract
Between 1986 and 1996, 16 infants and children less than 11 years of age (m = 11, f = 5) underwent resections for acquired or congenital tracheobronchial stenoses. During this period, various techniques of total intravenous anaesthesia (TIVA) were employed (midazolam, fentanyl, pancuronium; propofol, fentanyl, pancuronium). During the phase of dividing the airways, high-frequency-jet ventilation (HFJV) into the trachea or the main bronchi by 8-12Fr catheter(s) was applied for 10-75 min with driving pressures between 0.3-1.8 bar, frequencies between 100-200/min, I:E ratio between 1:4-1:1, and FjetO2 1.0. Catheter position was controlled visually, gas exchange was monitored by pulse oximetry and blood gas analysis. There were two incidents of transient hypoxaemia (paO2 less than 60 mmHg), and 4 cases of hypercapnia (paCO2 more than 45 mmHg). No complications due to the HFJV-catheter technique, such as barotrauma or aspiration were seen. All children were kept postoperatively on a ventilator due to swelling of the airway anastomosis. In 5 children ventilator treatment exceeded 7 days, 3 children were discharged tracheostomised. These observations serve to confirm that HFJV is capable of maintaining gas exchange during tracheal resection in infants and children, if the following prerequisites are met: 1. Tracheobronchial pathology suitable for poststenotic placement of jet catheter. 2. No respiratory impairment by parenchymal pathology. 3. Monitoring by continuous visual control of respiratory mechanics, pulse oximetry and blood gas analysis. Cardiopulmonary bypass should be applied if airway pathology precludes safe placement of jet catheters, or in the presence of parenchymal respiratory failure.
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Affiliation(s)
- C Männle
- Abt. für Anästhesiologie und Intensivmedizin, Thoraxklinik der LVA Baden, Heidelberg
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Affiliation(s)
- K Wiedemann
- Abteilung für Anästhesiologie und Intensivmedizin, Thoraxklinik der LVA Baden, Heidelberg
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Abstract
A 63-year-old man underwent distal oesophagectomy and proximal gastrectomy. Postoperatively, controlled ventilation was necessary for 53 days because of anastomotic leakage. Multiple sedative regimens proved to be inadequate. By contrast, a fentanyl-midazolam combination with continuous supplementation of clonidine 0.014 micrograms kg-1 min-1 (1.44 mg 70 kg-1 24 h-1) was very effective in terms of sedation and pain relief. During combined fentanyl-midazolam and clonidine infusion, cardiovascular depression gradually developed over several days necessitating the institution of a dobutamine infusion (dose: 8-12 micrograms kg-1 min-1). Four attempts of abrupt clonidine withdrawal were followed by sympathetic overshoot reactions consisting of tachycardia, hypertension, agitation, and sweating. Discontinuation of clonidine was finally possible after a 12-day weaning period.
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Affiliation(s)
- H Böhrer
- Department of Anaesthesia, University of Heidelberg, FRG
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Bach A, Layer M. [Muscle relaxants for kidney transplantation. A comparison between vecuronium and atracurium]. Anaesthesist 1990; 39:96-100. [PMID: 1968728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A total of 26 patients with end-stage renal failure were assigned randomly to receive either atracurium (A) or vecuronium (V) for intra-operative relaxation during kidney transplantation. Following the induction of balanced anesthesia an initial bolus dose of A 0,5 mg/kg body weight (BW) or V 0,1 mg/kg BW was administered. Relaxation was maintained by repeated doses of A 0,1 mg/kg BW or V 0,02 mg/kg BW whenever the twitch height (T1) recovered to 20% of the control value. Neuromuscular function was monitored throughout using the train-of-four twitch technique. There were no significant differences in time of onset (A: 219 +/- 87 s, V: 206 +/- 70 s), initial clinical duration (T1 = 0% to T1 = 20%; A: 39 +/- 12 min, V 39 +/- 8 min) or recovery index (A: 19 +/- 6 min, V: 22 +/- 7 min). The clinical duration (T1 = 20% to T1 = 20%) was significantly different for A, with 27 +/- 9 min than for V, with 32 +/- 7 min (P less than 0.05, Wilcoxon-Mann-Whitney U-Test; all values means +/- standard deviation). Reversal of relaxants was mandatory according to electromyographic and clinical criteria in only one patient in the A group but in 5 in the V group (P less than 0.05, Fisher's exact test). We conclude that A might be more suitable in patients with renal insufficiency and that monitoring of neuromuscular transmission is highly valuable in this risk group.
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Affiliation(s)
- A Bach
- Klinik für Anaesthesiologie, Universität Heidelberg
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